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Patient Factors Associated with Opioid Consumption in the Month Following Major Surgery

Larach, Daniel B. MD, MTR, MA*; Sahara, Michael J. BA; As-Sanie, Sawsan MD, MPH; Moser, Stephanie E. PhD; Urquhart, Andrew G. MD§; Lin, Jules MD; Hassett, Afton L. PsyD; Wakeford, Joseph A. BS; Clauw, Daniel J. MD; Waljee, Jennifer F. MD, MPH, MS; Brummett, Chad M. MD

doi: 10.1097/SLA.0000000000003509
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Objective: The aim of this study was to determine preoperative patient characteristics associated with postoperative outpatient opioid use and assess the frequency of postoperative opioid overprescribing.

Summary Background Data: Although characteristics associated with inpatient opioid use have been described, data regarding patient factors associated with opioid use after discharge are lacking. This hampers the development of individualized approaches to postoperative prescribing.

Methods: We included opioid-naïve patients undergoing hysterectomy, thoracic surgery, and total knee and hip arthroplasty in a single-center prospective observational cohort study. Preoperative phenotyping included self-report measures to assess pain severity, fibromyalgia survey criteria score, pain catastrophizing, depression, anxiety, functional status, fatigue, and sleep disturbance. Our primary outcome measure was self-reported total opioid use in oral morphine equivalents. We constructed multivariable linear-regression models predicting opioids consumed in the first month following surgery.

Results: We enrolled 1181 patients; 1001 had complete primary outcome data and 913 had complete phenotype data. Younger age, non-white race, lack of a college degree, higher anxiety, greater sleep disturbance, heavy alcohol use, current tobacco use, and larger initial opioid prescription size were significantly associated with increased opioid consumption. Median total oral morphine equivalents prescribed was 600 mg (equivalent to one hundred twenty 5-mg hydrocodone pills), whereas median opioid consumption was 188 mg (38 pills).

Conclusions: In this prospective cohort of opioid-naïve patients undergoing major surgery, we found a number of characteristics associated with greater opioid use in the first month after surgery. Future studies should address the use of non-opioid medications and behavioral therapies in the perioperative period for these higher risk patients.

*Department of Anesthesiology, University of Southern California, Los Angeles, CA

Department of Anesthesiology, University of Michigan, Ann Arbor, MI

Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI

§Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI

Department of Surgery, University of Michigan, Ann Arbor, MI.

cbrummet@umich.edu.

D.B.L. and M.J.S. contributed equally to the work.

Funding: C.M.B. has received research funding from Neuros Medical (Willoughby Hills, OH), not related to the present work. He is also a consultant for Heron Therapeutics (San Diego, CA, not related to this work. D.J.C. has received research funding from Cerephex (Los Altos, CA), Forest Laboratories (New York, NY), Merck (Kenilworth, NJ), and Pfizer (New York, NY), and serves as a consultant for Tonix Pharmaceuticals (New York, NY), Pfizer, Depomed (Newark, CA), Samumed (San Diego, CA), Aptinyx (Evanston, IL), and Zynerba Pharmaceuticals (Devon, PA); all not related to this work. A.L.H. is a consultant for AbbVie (North Chicago, IL); not related to this work. S.A-S. is a consultant for AbbVie, Myovant Sciences (Brisbane, CA), and Bayer (Leverkusen, Germany); not related to this work.

The study was funded by the following NIH grants: NIAMS R01AR060392 (MPI Clauw and Brummett), NIDA R01DA038261 (MPI Clauw and Brummett) and NIDA R01DA042859 (MPI Waljee and Brummett). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Drug Abuse, or the National Institutes of Health. Additional funding was provided by the Department of Anesthesiology, the Medical School Dean's Office, and the Michigan Genomics Initiative of the University of Michigan (Ann Arbor, MI). The study sponsors had no role in the design, conduct, collection, analysis, or interpretation of this study, or the preparation, review, or approval of the manuscript.

The authors report no conflicts of interest.

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