Prolonged Opioid Use and Pain Outcome And Associated Factors after Surgery Under General Anesthesia: A Prospective Cohort Association Multicenter Study

Kai Kuck; Bhiken I Naik; Karen B Domino; Karen L Posner; Leif Saager; Ami R Stuart; Ken B Johnson; Salome B Alpert; Marcel E Durieux; Anik K Sinha; Chad M Brummett; Michael F Aziz; Kenneth C Cummings Iii; John G Gaudet; Andrea Kurz; Mienke Rijsdijk; Jonathan P Wanderer; Nathan L Pace

doi:10.1097/ALN.0000000000004510

Prolonged Opioid Use and Pain Outcome And Associated Factors after Surgery Under General Anesthesia: A Prospective Cohort Association Multicenter Study

Anesthesiology. 2023 Jan 24. doi: 10.1097/ALN.0000000000004510. Online ahead of print.

Authors

Kai Kuck¹, Bhiken I Naik², Karen B Domino³, Karen L Posner⁴, Leif Saager⁵, Ami R Stuart⁶, Ken B Johnson⁷, Salome B Alpert⁸, Marcel E Durieux⁹, Anik K Sinha¹⁰, Chad M Brummett¹¹, Michael F Aziz¹², Kenneth C Cummings Iii¹³, John G Gaudet¹⁴, Andrea Kurz¹⁵, Mienke Rijsdijk¹⁶, Jonathan P Wanderer¹⁷, Nathan L Pace¹⁸

Affiliations

¹ Anesthesiology, University of Utah, Salt Lake City, UT (USA) Director of Bioengineering Research.
² Anesthesiology and Neurological Surgery, University of Virginia, Charlottesville, VA (USA) Associate Professor of Anesthesiology and Neurological Surgery.
³ Anesthesiology & Pain Medicine, University of Washington, Seattle, WA (USA) Vice Chair for Clinical Research.
⁴ Anesthesiology & Pain Medicine, University of Washington, Seattle, WA (USA) Research Professor Emeritus.
⁵ Anesthesiology, University Medical Center Göttingen, Göttingen, (Germany) and Anesthesiology, University of Michigan, Ann Arbor, MI (USA) Executive Vice Chair.
⁶ Patient Monitoring, Medtronic, Boulder, CO (USA) Sr. Clinical Research Specialist.
⁷ Anesthesiology, University of Utah, Salt Lake City, UT (USA) Vice Chair for Research.
⁸ Anesthesiology, University of Virginia, Charlottesville, VA (USA) Clinical Scientist.
⁹ Anesthesiology, University of Virginia, Charlottesville, VA (USA) Emeritus professor.
¹⁰ Anesthesiology, University of Michigan, Ann Arbor, MI (USA) Software Engineer / Developer.
¹¹ Anesthesiology, University of Michigan, Ann Arbor, MI (USA) Bert N LaDu Professor of Anesthesiology and Senior Associate Chair for Research.
¹² Anesthesiology & Perioperative Medicine, Oregon Health & Science University, Portland, OR (USA) Vice Chair for Clinical Affairs.
¹³ Anesthesiology Institute, Cleveland Clinic, Cleveland, OH (USA) Staff Anesthesiologist.
¹⁴ Anesthesiology, Lausanne University Hospital, Lausanne (Switzerland) Head of Neuro-Spine Anesthesia Unit.
¹⁵ Anesthesia, Cleveland Clinic, Cleveland (USA) and University of Graz, Graz (Austria) Vice.
¹⁶ Anesthesiology, University Medical Center Utrecht, Utrecht (Netherlands) Head of Pain Medicine.
¹⁷ Anesthesiology, Vanderbilt University Medical Center, Nashville, TN (USA) Medical Director, Perioperative Informatics.
¹⁸ Anesthesiology, University of Utah, Salt Lake City, UT (USA) Professor.

PMID: 36692360
DOI: 10.1097/ALN.0000000000004510

Abstract

Introduction: There is insufficient prospective evidence regarding the relationship between surgical experience and prolonged opioid use and pain. We investigated the association of patient characteristics, surgical procedure, and perioperative anesthetic course with postoperative opioid consumption and pain three months post surgery. We hypothesized patient characteristics and intraoperative factors predict opioid consumption and pain three months post surgery.

Methods: Eleven U.S. and one European institution enrolled patients scheduled for spine, open thoracic, knee, hip, or abdominal surgery, or mastectomy in this multicenter, prospective observational study. Preoperative and postoperative data was collected using patient surveys and electronic medical records. Intra-operative data were collected from the Multicenter Perioperative Outcomes Group database. The association between postoperative opioid consumption and surgical site pain at three months, elicited from a telephone survey conducted at three months postoperatively, and demographics, psycho-social scores, pain scores, pain management, and case characteristics, was analyzed.

Results: Between September and October 2017, 3,505 surgical procedures met inclusion criteria. 1,093 cases were included; 413 patients were lost to follow-up, leaving 680 (64%) for outcome analysis. Preoperatively, 135 (20%) patients were taking opioids. Three months post surgery, 96 (14%) patients were taking opioids, including 23 patients (4%) who had not taken opioids preoperatively. 177 patients (27%) reported surgical site pain, including 45 (13%) patients who had not reported pain preoperatively. The adjusted odds ratio for 3-month opioid use was 18.6 (Credible Interval 10.3- 34.5) for patients who had taken opioids preoperatively. The adjusted odds ratio for three-month surgical site pain was 2.58 (1.45-4.4), 4.1 (1.73-8.9), and 2.75 (1.39-5.0) for patients who had site pain preoperatively, knee replacement, or spine surgery, respectively.

Conclusions: Preoperative opioid use was the strongest predictor of opioid use three months post surgery. None of the other variables showed clinically significant association with opioid use at three months after surgery.