Predictive Factors for Postoperative Opioid Use in Elective Skull Base Craniotomies

Area of Science:

• Neurosurgery
• Pain Management
• Public Health

Background:

• Opioid overuse is a significant public health emergency in the United States.
• Limited benchmark data exists for postoperative opioid use in skull base neurosurgery.
• Quantifying opioid consumption and identifying influencing factors are crucial for effective pain management.

Purpose of the Study:

• To quantify postoperative opioid use in patients undergoing skull base craniotomies.
• To identify demographic and perioperative factors associated with opioid consumption.
• To inform strategies for minimizing opioid use in neurosurgical patients.

Main Methods:

• Retrospective analysis of 300 elective skull base craniotomies (January 2015 - May 2020).
• Data extracted from electronic medical records, including demographics and perioperative details.
• Linear regression models used to identify predictors of opioid use at 24, 48, and 72 hours post-surgery.

Main Results:

• A history of anxiety/depression, preoperative opioid use, and migraines predicted increased postoperative opioid use.
• Younger age and minimal muscle dissection were associated with lower opioid consumption.
• Sex, surgical approach (supratentorial vs. infratentorial), surgery length, and steroid use did not significantly impact opioid use.

Conclusions:

• Patient-specific factors (age, mental health history, migraine history, prior opioid use) significantly influence postoperative opioid needs.
• Surgical factors, specifically the extent of muscle dissection, also play a role in opioid consumption.
• Identifying these risk factors can guide personalized pain management strategies to reduce opioid reliance after skull base surgery.