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A Systematic Review of the Relative Frequency and Risk Factors for Prolonged Opioid Prescription Following Surgery and Trauma Among Adults

Pagé, M. Gabrielle PhD*,†; Kudrina, Irina MD, CM; Zomahoun, Hervé Tchala Vignon PhD§,¶; Croteau, Jordie MSc; Ziegler, Daniela MSi||; Ngangue, Patrice PhD*,**; Martin, Elisabeth MSc*; Fortier, Maude BSc*; Boisvert, Esthelle Ewusi BA*; Beaulieu, Pierre MD, PhD††; Charbonneau, Céline‡‡; Cogan, Jennifer MD, MSc†,§§; Daoust, Raoul MD, MSc¶¶,****; Martel, Marc O. PhD||||; Néron, Andrée BPharm, FOPQ***; Richebé, Philippe MD, PhD†††; Clarke, Hance MD, PhD‡‡‡,§§§

doi: 10.1097/SLA.0000000000003403
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Objective: The aim of this study was to examine the relative frequency of and risk factors for prolonged opioid prescription (Rx_3–6: ≥1 opioid prescription of any length between 3 and 6 months postevent) and long-term opioid prescription (Rx_>6: ≥1 opioid prescription of any length >6 months postevent) after surgery/trauma.

Summary Background Data: Eighty percent of patients undergoing surgery are prescribed opioids; for many this initial time-limited therapy continues for months after surgery.

Methods: Included studies were published between January 1998 and April 2018, examined opioid use ≥3 months after surgery/trauma requiring hospitalization, and considered pre-event opioid prescription status. Empirical studies were identified via a systematic literature search. Two independent reviewers assessed studies for inclusion and conducted data extraction and quality appraisal.

Results: Thirty-five of the 10,003 screened articles were included; most were retrospective studies of medicoadministrative databases; all studies were observational. The median relative frequency of Rx_3–6 and Rx_>6 was 4.1% and 2.6%, respectively, among patients with no/short-term opioid prescription pre-event and 50.9% and 58.5%, respectively, among patients with prolonged opioid prescription pre-event. Income levels, tobacco dependence, use of antidepressants, and pre-event opioid prescriptions are associated with increased risk of Rx_3–6/Rx_>6. The use of benzodiazepines (current use) or muscle relaxants and the presence of alcohol/drug dependence were found to be potential risk factors for Rx_3–6/Rx_>6 among patients with no/short-term opioid prescription pre-event.

Conclusions: Identified risk factors for Rx_3–6/Rx_>6 were predominantly psychosocial factors. This points to the importance of assessing mental and social health before surgery and acutely during hospitalization to ensure safe and optimal recovery.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

*Research center of the Centre Hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada

Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada

Department of Family Medicine and Department of Anesthesia, Faculty of Medicine, McGill University, Montreal, Quebec, Canada

§Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Quebec, Canada

Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR-SUPPORT Unit, Quebec, Canada

||CHUM Library, Centre hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada, Montreal, Quebec, Canada

**Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada

††Department of Anesthesiology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, Quebec, Canada

‡‡Quebec Association of Chronic Pain (AQDC), Montreal, Quebec, Canada

§§Department of Anesthesiology, Montreal Heart Institute, Montreal, Quebec, Canada

¶¶Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada

||||Faculty of Dentistry & Department of Anesthesia, McGill University, Montreal, Quebec, Canada

***Pain Clinic, Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montreal, Quebec, Canada

†††Department of Anesthesiology, Hôpital Maisonneuve-Rosemont CIUSSS de l’Est de l’Ile de Montreal, Université de Montréal, Montreal, Quebec, Canada

‡‡‡Department of Anesthesia and Pain Management, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

§§§Transitional Pain Service, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada

****Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.

gabrielle.page@umontreal.ca.

This systematic review is funded and sponsored by the Canadian Institutes of Health Research Operating Grant: Opioid Crisis Knowledge Synthesis # 397974. The study team has received in-kind contribution from the “Health and Social Services Systems, Knowledge Translation and Implementation” component of the Quebec SPOR-SUPPORT Unit. Hance Clarke is supported by a Research Merit Award from the Department of Anesthesia at the University of Toronto.

The authors report no conflicts of interests.

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