Abstract
Background
Preoperative chronic opioid use is common, but it is unclear whether complete opioid
tapering can be achieved postoperatively without adversely affecting pain control
and quality of life. This study was designed to assess the association between complete
opioid tapering after surgery and patient-reported outcomes for pain intensity and
pain interference.
Methods
We identified chronic opioid use patients undergoing a spectrum of nonemergency surgical
procedures at a single Veterans Affairs medical institution between December 2017
and 2021. All patients were prospectively followed by a transitional pain service
that promoted opioid tapering, assessed opioid use (morphine milligram equivalent),
and patient-reported outcomes measurement information system for pain intensity (PROMIS-3a)
and pain interference (PROMIS-6b). After stratifying based on whether complete versus
partial/no opioid tapering was achieved after surgery, longitudinal changes in patient-reported
outcomes and morphine milligram equivalents were compared over time. Independent predictors
of complete opioid tapering were assessed using logistic regression models.
Results
In total, 341 surgical patients (91% male, mean age 64 years) with chronic opioid
use underwent surgery during the study period, of which 44 (13%) completely tapered
off opioids within 60 days after discharge from the hospital. Patients who completely
tapered had significant improvement in the change in patient-reported outcomes for
pain intensity and interference with significant differences at 30 and 60 days after
discharge for both measures when compared to the partial/no taper group (both P < .05). In risk-adjusted analyses, patients with lower baseline morphine milligram
equivalents and those staying longer in the hospital were more likely to achieve complete
opioid tapering (both P < .01).
Conclusion
Complete opioid tapering can be successfully achieved after surgery among patients
with chronic opioid use with corresponding improvements in self-reported pain intensity
and pain interference. Our results suggest that the highest potential for improving
patient-reported outcomes with opioid tapering occurs among patients undergoing orthopedic
procedures early after surgical discharge.
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References
- Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgery.JAMA Surg. 2018; 153: 929-937
- Prevalence of chronic opioid use in patients with peripheral arterial disease undergoing revascularization.J Vasc Surg. 2022; 75: 186-194
Aneizi A, Gelmann D, Ventimiglia DJ, et al. Preoperative opioid use in patients undergoing common hand surgeries. Hand (N Y). Jan 19 2021:1558944720974122. https://doi.org/10.1177/1558944720974122
- Preoperative opioid use in patients undergoing shoulder surgery.Shoulder Elbow. 2021; 13: 248-259
- Patterns of pre-operative opioid use affect the risk for complications after total joint replacement.Sci Rep. 2021; 11: 22124
- Preoperative opioid use is an independent risk factor for complication, revision, and increased health care utilization following primary total shoulder arthroplasty.J Shoulder Elbow Surg. 2021; 30: 1025-1033
- Opioid use disorder in patients undergoing primary 1- to 2-level anterior cervical discectomy and fusion is associated with longer in-hospital lengths of stay and higher rates of readmissions, complications, and costs of care.Global Spine J. Aug. 2021; 1921925682211037265https://doi.org/10.1177/21925682211037265
- Association of preoperative opioid use with mortality and short-term safety outcomes after total knee replacement.JAMA Netw Open. 2019; 2e198061
- Association between preoperative opioid and benzodiazepine prescription patterns and mortality after noncardiac surgery.JAMA Surg. 2019; 154e191652
- Multidisciplinary transitional pain service for the veteran population.Fed Pract. 2020; 37: 472-478
- Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service.Reg Anesth Pain Med. 2020; 45: 847-852
- Shared decision-making approach to taper postoperative opioids in spine surgery patients with preoperative opioid use: a randomized controlled trial.Pain. 2022; 163: e634-e641
- Patients’ perspectives on tapering of chronic opioid therapy: a qualitative study.Pain Med. 2016; 17: 1838-1847
- STROBE reporting guidelines for observational studies.JAMA Surg. 2021; 156: 577-578
- Minimally important differences for patient reported outcomes measurement information system pain interference for individuals with back pain.J Pain Res. 2016; 9: 251-255
- Minimal clinically important difference and substantial clinical benefit using PROMIS CAT in cervical spine surgery.Clin Spine Surg. 2019; 32: 392-397
- Trends and predictors of opioid use after total knee and total hip arthroplasty.Pain. 2016; 157: 1259-1265
- Efficacy of motivational-interviewing and guided opioid tapering support for patients undergoing orthopedic surgery (MI-Opioid Taper): a prospective, assessor-blind, randomized controlled pilot trial.EClinicalMedicine. 2020; 28: 100596
- Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system.BMJ Qual Saf. 2021; 30: 251-259
- Patient-reported opioid consumption and pain intensity after common orthopedic and urologic surgical procedures with use of an automated text messaging system.JAMA Netw Open. 2021; 4e213243
- Opioid tapering after surgery: a qualitative study of patients’ experiences.Scand J Pain. 2020; 20: 555-563
- Patients’ experience with opioid tapering: a conceptual model with recommendations for clinicians.J Pain. 2019; 20: 181-191
Article info
Publication history
Published online: June 07, 2022
Accepted:
April 21,
2022
Identification
Copyright
Published by Elsevier Inc.
