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.


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.