Perioperative Systemic Analgesia in Patients With Inflammatory Skin Disease: A Matched Cohort Study

Chronic inflammatory dermatoses are associated with altered nociception and increased opioid use in nonsurgical settings, but perioperative analgesic prescribing in this population has not been well characterized. We compared perioperative analgesic use, recorded postoperative pain, and surgical outcomes between surgical patients with and without inflammatory skin disease.

We conducted a retrospective propensity score-matched cohort study using the TriNetX federated electronic health record network. Patients with inflammatory dermatoses undergoing surgery were matched 1:1 to controls without inflammatory skin disease. A secondary matched cohort of patients with postprocedural pain was analyzed to evaluate analgesic prescribing following documented postoperative pain. Outcomes included opioid and non-opioid analgesic use, postoperative pain, complications, and postoperative nausea and vomiting (PONV).

After matching, the surgical cohort included 38,569 patients per group and the postprocedural-pain cohort included 149,002 patients per group. Thirty-day opioid use, the primary outcome, was lower in the inflammatory cohort than in controls (3.2% vs 7.0%; risk difference (RD), -3.8 percentage points; 95% confidence interval (CI), -4.2 to -3.4; risk ratio (RR), 0.46; 95% CI, 0.42-0.50), with lower opioid and non-opioid analgesic use persisting across the evaluated follow-up periods. Despite reduced analgesic use, recorded postoperative pain was similar at 30 days and higher during longer follow-up. PONV occurred more frequently in patients with inflammatory dermatoses, while most other postoperative complications were comparable between groups.

Patients with inflammatory dermatoses received less perioperative systemic analgesia despite no reduction in recorded postoperative pain. Because lower prescribing alone cannot establish undertreatment without validated pain severity or patient-reported outcomes, we interpret these associations as hypothesis-generating; they identify a potential difference in perioperative pain management and highlight the need for prospective studies to better define analgesic needs in surgical patients with inflammatory skin disease.