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Association Between Complications after Vascular Surgery and Prolonged Postoperative Opioid Use
Luc Dubois1, J Andrew McClure2, Kelly Vogt3
1Department of Surgery, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; ICES Western, London, Ontario, Canada.
Annals of Vascular Surgery
|October 6, 2023
Summary
Prolonged opioid use is common after major vascular surgery, especially after lower extremity revascularization (LER). Prior opioid use is the strongest predictor, highlighting the need for targeted opioid reduction strategies.
Area of Science:
- Vascular Surgery
- Pain Management
- Pharmacology
Background:
- Limited research exists on long-term opioid use post-major vascular surgery.
- No studies have explored the link between major complications and prolonged opioid use.
Purpose of the Study:
- To investigate factors associated with prolonged opioid use after major vascular surgery.
- To analyze the association between major complications and prolonged opioid use.
Main Methods:
- Population-based cohort study in Ontario, Canada (2013-2018).
- Included open lower extremity revascularization (LER), endovascular aneurysm repair (EVAR), and open abdominal aortic aneurysm repair (AAA).
- Prolonged opioid use defined as ≥2 prescriptions filled 6-12 months post-surgery; analyzed using modified Poisson regression.
Main Results:
- Prolonged opioid use observed in 26.1% of LER, 13.2% of AAA, and 11.6% of EVAR patients.
- Prior opioid use was the strongest predictor (OR 4.69-13.27).
- Major complications increased prolonged use risk in LER (OR 1.10) but had a protective effect in EVAR (OR 0.83). Older age reduced prolonged use risk across all procedures.
Conclusions:
- Prolonged opioid use is prevalent after major vascular surgery, particularly LER.
- Prior opioid use is the key predictor for prolonged use.
- Targeted multimodal opioid reduction strategies are recommended for high-risk patient groups.
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