Postdischarge Pain Management After Thoracic Surgery: A Patient-Centered Approach

Published on Nov 1, 2020in The Annals of Thoracic Surgery4.33
· DOI :10.1016/J.ATHORACSUR.2020.04.048
Benjamin A. Abrams4
Estimated H-index: 4
(Anschutz Medical Campus),
Kimberly A. Murray2
Estimated H-index: 2
(Maine Medical Center)
+ 10 AuthorsKarsten Bartels19
Estimated H-index: 19
(Anschutz Medical Campus)
Sources
Abstract
Abstract Background Postoperative analgesia is paramount to recovery following thoracic surgery, and opioids play an invaluable role in this process. Yet, current one-size-fits-all prescribing practices produce large quantities of unused opioids, increasing the risk of nonmedical use and overdose. Here, we hypothesized that patient and perioperative characteristics, including 24-hour before discharge opioid intake, could inform more appropriate post-discharge prescriptions after thoracic surgery. Methods We conducted a prospective observational cohort study in 200 adult thoracic surgery patients. The cohort was divided into three groups based on 24-hour before discharge opioid intake in morphine milligram equivalents (MME): 1) no (0 MME), 2) low (>0 ≤112.5 MME), or 3) high (>112.5 MME) before discharge opioid intake. Logistic regression was used to analyze the association of patient and perioperative characteristics with self-reported after discharge opioid use. Results Univariate analysis showed preoperative opioid use, 24-hour before discharge acetaminophen and gabapentinoid intake, and 24-hour before discharge opioid intake were associated with higher after discharge opioid use. Multivariable modeling demonstrated that 24-hour prior to discharge opioid intake was most significantly associated with after discharge opioid use. For example, compared to patients who took high amounts of opioids prior to discharge, patients who took no opioids prior to discharge were 99% less likely to take a high amount of opioids after discharge compared to taking none (OR 0.011; 95% CI 0.003-0.047; P Conclusions Assessment of 24-hour before discharge opioid intake may inform patient requirements after discharge. Opioid prescriptions after thoracic surgery can thereby be targeted based on anticipated needs.
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#1Alexander A. Brescia (UM: University of Michigan)H-Index: 12
#2Jennifer F. Waljee (UM: University of Michigan)H-Index: 42
Last. Kiran H. Lagisetty (UM: University of Michigan)H-Index: 7
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Background New persistent opioid use occurs in 3% to 14% of patients after elective surgery, but is poorly described after cardiothoracic surgery. We examined the association of prescription size with new persistent opioid use after cardiothoracic surgery. Methods Opioid-naive Medicare patients undergoing cardiothoracic surgery between 2009 and 2015 were identified. Patients who filled an opioid prescription between 30 days before surgery and 14 days after discharge and with continuous Medicare ...
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#1Alexander A. Brescia (UM: University of Michigan)H-Index: 12
#2Caitlin A. Harrington (OHSU: Oregon Health & Science University)H-Index: 3
Last. Kiran H. Lagisetty (UM: University of Michigan)H-Index: 7
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Background Opioid dependence, misuse, and abuse in the United States continue to rise. Prior studies indicate an important risk factor for persistent opioid use includes elective surgical procedures, though the probability following thoracic procedures remains unknown. We analyzed the incidence and factors associated with new persistent opioid use after lung resection. Methods We evaluated data from opioid-naive cancer patients undergoing lung resection between 2010 and 2014 using insurance clai...
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Background There is a paucity of data to inform appropriate opioid prescribing for patients who are discharged after a hospital admission for a surgical procedure. Study Design We studied 333 inpatients discharged to home after bariatric, benign foregut, liver, pancreas, ventral hernia, and colon surgery. Chronic opioid users or patients who had complications were excluded. Home opioid usage was quantified in 90% of the remaining patients by questionnaires and phone surveys. Results Eighty-five ...
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Last. Christopher L. Wu (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 68
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Importance Prescription opioid analgesics play an important role in the treatment of postoperative pain; however, unused opioids may be diverted for nonmedical use and contribute to opioid-related injuries and deaths. Objective To quantify how commonly postoperative prescription opioids are unused, why they remain unused, and what practices are followed regarding their storage and disposal. Evidence Review MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials were searched from dat...
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#2Corey J. Hayes (University of Arkansas for Medical Sciences)H-Index: 11
Last. Bradley C. Martin (University of Arkansas for Medical Sciences)H-Index: 44
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Abstract The relationships between the initial opioid prescription characteristics and pain etiology with the probability of opioid discontinuation were explored in this retrospective cohort study using health insurance claims data from a nationally representative database of commercially insured patients in the United States. We identified 1,353,902 persons aged 14 years and older with no history of cancer or substance abuse, with new opioid use episodes and categorized them into 11 mutually ex...
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#1Maureen V. Hill (Dartmouth–Hitchcock Medical Center)H-Index: 7
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Objective:To examine opioid prescribing patterns after general surgery procedures and to estimate an ideal number of pills to prescribe.Background:Diversion of prescription opioids is a major contributor to the rising mortality from opioid overdoses. Data to inform surgeons on the optimal dose of op
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#1R. Scott Jones (UVA: University of Virginia)H-Index: 21
#2George J. Stukenborg (UVA: University of Virginia)H-Index: 29
Background Surgeons recognize the importance of patient reported outcomes in the evaluation of health care. Documenting health related quality of life (HRQOL) can enhance surgical quality improvement efforts. Systematic documentation of HRQOL began in 1963. Currently, multiple varied and unstandardized instruments make it difficult to compare quality of life measures across studies. The NIH developed the Patient Reported Outcomes Measurement Information System (PROMIS) to provide a standardized ...
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Last. Duminda N. Wijeysundera (St. Michael's Hospital)H-Index: 76
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#2Hong K. Kim (UMB: University of Maryland, Baltimore)H-Index: 5
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: There is an epidemic of opioid abuse. This article discusses the history of opioid use. Abusers of opioids are at great risk of harm. There have been increasing legislative efforts to curb this abuse and we present a review of the current state of these laws. Naloxone has made a profound impact in the care of these patients if they present for medical care early enough. This paper discusses naloxone pharmacodynamics, its use in the medical setting, and how its use is now being expanded to incl...
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