D. C. Cron1, J. S. Lee1, M. Hu1, L. Zhong2, P. E. Hilliard3, M. J. Englesbe1, C. M. Brummett3, J. F. Waljee2 1University Of Michigan Medical School,Surgery,Ann Arbor, MI, USA 2University Of Michigan Medical School,Plastic Surgery,Ann Arbor, MI, USA 3University Of Michigan Medical School,Anesthesiology,Ann Arbor, MI, USA
Introduction: Chronic opioid use is increasingly prevalent, poses challenges for perioperative management, and may increase risk of surgical complications. To better understand this growing high-risk surgical population, we studied the effect of preoperative chronic opioid use on postoperative complications.
Methods: We used the Truven Health MarketScan Commercial Claims and Encounters Database, encompassing over 100 U.S. health plans, to identify adults who underwent elective surgery between 7/2009-12/2012 (N=338,011). We included minor surgeries (N=259,873; varicose vein ablation, hemorrhoidectomy, laparoscopic appendectomy, laparoscopic cholecystectomy, prostatectomy, thyroidectomy, parathyroidectomy, and carpal tunnel release) and major surgeries (N=78,138; colectomy, ventral hernia, bariatric, gastric reflux, and hysterectomy). The primary exposure, preoperative opioid use, was defined as ≥1 opioid prescription filled both within 30 days and also between 30-90 days preoperatively. The secondary exposure was preoperative 90-day mean morphine equivalents (MME). The outcome was 30-day major complications, and we used logistic regression to risk adjust for procedure type and patient clinical and demographic characteristics.
Results: The prevalence of preoperative chronic opioid use was 5.5% overall, 5.3% among minor surgery, and 6.2% among major surgery. In opioid users compared to opioid-naïve, risk-adjusted complication rates (≥1 complication) were 1.4 times higher overall (5.1% vs. 3.7%; p<0.001), 1.3 times higher after minor surgery (3.3% vs. 2.5%; p<0.001), and 1.4 times higher after major surgery (10.9% vs. 7.9%; p<0.001). Opioid use in the overall group was significantly associated with surgical site infection (1.7% vs. 1.2%), pulmonary failure (1.1% vs. 0.7%), renal failure (0.8% vs. 0.7%), hemorrhage (1.2% vs. 0.8%), and GI bleeding (0.9% vs. 0.6%). The figure shows overall complication rates by preoperative MME; there was a statistically significant trend overall with increasing preoperative opioid dose associated with increased complications (p-value for trend <0.001).
Conclusion: Chronic opioid use prior to elective surgery was associated with increased risk of postoperative complications in this population-based study. This higher risk surgical population may require more aggressive and tailored perioperative care to prevent and manage complications. Preoperative interventions attempting to wean opioids will be difficult but may improve surgical outcomes.
