Incidence and Risk Factors for Prolonged Opioid Analgesic Use in Opioid-Naive Patients Following Pancreaticoduodenectomy.

Abstract

Background: Effective pain management is essential for patients undergoing pancreaticoduodenectomy (PD) due to the complexity of the surgery. Opioid analgesics (OA) are commonly used for pain relief but can lead to prolonged postoperative use, posing significant health risks. This study examines the incidence and risk factors of prolonged OA use among opioid-naive patients following PD.

Methods: This retrospective cohort study included patients who underwent PD from 2010 to 2022 at National Taiwan University Hospital, excluding those with preoperative opioid use, emergent PD, minimally invasive procedures, opioid dependence, or in-hospital death. Prolonged OA use was defined as filling at least one OA prescription between 31 and 60 days postoperatively. Statistical analyses included univariate and multivariate logistic regression models to identify risk factors.

Results: Among the 1309 patients, 224 (17.1%) filled at least one OA prescription between 31 and 60 days after PD. Multivariate analysis identified BMI (OR = 1.06, 95% CI = 1.02-1.10, p = 0.001), chronic pancreatitis (OR = 1.82, 95% CI = 1.13-2.94, p = 0.013), and epidural analgesia use (OR = 2.40, 95% CI = 1.64-3.52, p < 0.001) as factors associated with prolonged OA use.

Conclusion: This study reveals a 17.1% incidence of prolonged OA use among opioid-naive patients post-PD. These findings highlight the need for tailored pain management strategies to reduce prolonged opioid use and improve patient outcomes. Further research should focus on developing targeted interventions to mitigate opioid dependency in this population.