How perioperative processes and patient-reported outcomes contribute to persistent postoperative opioid use: A cohort study linking clinical and health claims data

Abstract

Background: Opioid analgesics play a major role in perioperative pain management, yet their use can lead to persistent postoperative opioid use (PPOU), with significant societal and health costs. Patient-specific risk factors of PPOU are well described but little is known about factors that can be controlled by clinicians.

Objectives: To find PPOU risk factors among perioperative processes and pain-related patient-reported outcomes (PROs) on the first postoperative day.

Design: Prospective cohort study linking perioperative data from Quality Improvement in Postoperative Pain Treatment (QUIPS) pain registry with health claims data from BARMER insurance.

Setting: Thirty-one German hospitals in 2021.

Patients: We analysed 1849 of 1994 patients undergoing surgery (mean age = 61.6 years ± 17.3, 60.7% women). Exclusion criteria: under 18 years, unable to communicate, not consenting, failed data linkage.

Main outcome measure: Persistent postoperative opioid use (PPOU), defined as at least one opioid prescription within 90 days postdischarge and another one between days 91 and 180.

Results: Overall, 7.8% of patients showed PPOU. In logistic regression models, preadmission opioid use, adjusted odds ratio (aOR) = 20.8, P < 0.001, and depression, aOR = 1.85, P = 0.006, were patient-specific risk factors. Opioid administration during the hospital stay was associated with 4% increase in adjusted absolute PPOU risk ( P = 0.001), with opioids on the ward standing out. Among PROs on the first postoperative day, higher maximal pain intensity (0.5% per point on 11-point Numeric Rating Scale, P = 0.023) was associated with an increased absolute PPOU risk while postoperative nausea (2.6% if yes, P = 0.034) was associated with a decreased absolute risk.

Conclusions: Perioperative opioids significantly contributed to the risk of PPOU, emphasising the need for careful opioid management postsurgery. Addressing pain effectively and promptly, while minimising opioid prescriptions on the ward, may reduce PPOU. Further research is needed to refine pain management and optimise patient outcomes.