Stephan G Frangakis, Bethany Kavalakatt, Vidhya Gunaseelan, Yenling Lai, Jennifer Waljee, Michael Englesbe, Chad M Brummett, Mark C Bicket
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Therefore, this study was designed to test the hypothesis that preoperative opioid exposure may impede recovery in the postoperative period.</p><p><strong>Methods: </strong>This retrospective cohort study used a statewide clinical registry from 70 hospitals linked to opioid fulfillment data from the state's prescription drug monitoring program to categorize patients' preoperative opioid exposure as none (naïve), minimal, intermittent, or chronic. Outcomes were patient-reported pain intensity (primary), as well as 30-day clinical and patient-reported outcomes (secondary).</p><p><strong>Results: </strong>Compared with opioid-naïve patients, opioid exposure was associated with higher reported pain scores at 30 days after surgery. Predicted probabilities were higher among the opioid exposed versus naive group for reporting moderate pain [43.5% (95% CI: 42.6%-44.4%) vs 39.3% (95% CI: 38.5%-40.1%)] and severe pain [13.% (95% CI: 12.5%-14.0%) vs 10.0% (95% CI: 9.5%-10.5%)], and increasing probability was associated increased opioid exposure for both outcomes. Clinical outcomes (incidence of emergency department visits, readmissions, and reoperation within 30 days) and patient-reported outcomes (reported satisfaction, regret, and quality of life) were also worse with increasing preoperative opioid exposure for most outcomes.</p><p><strong>Conclusions: </strong>This study is the first to examine the effect of presurgical opioid exposure on both clinical and nonclinical outcomes in a broad cohort of patients and shows that exposure is associated with worse postsurgical outcomes. A key question to be addressed is whether and to what extent opioid tapering before surgery mitigates these risks after surgery.</p>","PeriodicalId":8017,"journal":{"name":"Annals of surgery","volume":" ","pages":"234-241"},"PeriodicalIF":7.5000,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11399320/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Association of Preoperative Opioid Use with Postdischarge Outcomes: A Cohort Study of the Michigan Surgical Quality Collaborative.\",\"authors\":\"Stephan G Frangakis, Bethany Kavalakatt, Vidhya Gunaseelan, Yenling Lai, Jennifer Waljee, Michael Englesbe, Chad M Brummett, Mark C Bicket\",\"doi\":\"10.1097/SLA.0000000000006265\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To examine the association of prescription opioid fills over the year before surgery with postoperative outcomes.</p><p><strong>Background: </strong>Nearly one-third of patients report opioid use in the year preceding surgery, yet an understanding of how opioid exposure influences patient-reported outcomes after surgery remains incomplete. Therefore, this study was designed to test the hypothesis that preoperative opioid exposure may impede recovery in the postoperative period.</p><p><strong>Methods: </strong>This retrospective cohort study used a statewide clinical registry from 70 hospitals linked to opioid fulfillment data from the state's prescription drug monitoring program to categorize patients' preoperative opioid exposure as none (naïve), minimal, intermittent, or chronic. Outcomes were patient-reported pain intensity (primary), as well as 30-day clinical and patient-reported outcomes (secondary).</p><p><strong>Results: </strong>Compared with opioid-naïve patients, opioid exposure was associated with higher reported pain scores at 30 days after surgery. 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引用次数: 0
摘要
目的研究手术前一年阿片类药物处方用量与术后结果的关系：背景：近三分之一的患者报告在手术前一年内使用过阿片类药物，但对阿片类药物暴露如何影响患者报告的术后结果的了解仍不全面。因此，本研究旨在验证术前阿片类药物暴露可能会阻碍术后恢复的假设：这项回顾性队列研究使用了来自 70 家医院的全州临床登记册，并与州处方药监控计划的阿片类药物执行数据相链接，将患者的术前阿片类药物暴露分为无（新手）、极少、间歇或慢性暴露。结果是患者报告的疼痛强度（主要结果）以及30天临床和患者报告的结果（次要结果）：结果：与未使用阿片类药物的患者相比，术后30天内阿片类药物暴露与较高的疼痛评分相关。暴露于阿片类药物的患者与未使用阿片类药物的患者相比，报告中度疼痛（43.5% [95% CI 42.6 - 44.4%] vs 39.3% [95% CI 38.5 - 40.1%]）和重度疼痛（13.% [95% CI 12.5 - 14.0%] vs 10.0% [95% CI 9.5 - 10.5%]）的预测概率较高，而这两种结果的概率增加与阿片类药物暴露增加有关。临床结果（急诊室就诊率、再入院率和 30 天内再次手术率）和患者报告结果（满意度、遗憾和生活质量）也随着术前阿片类药物暴露的增加而恶化：本研究首次在一个广泛的患者群体中研究了手术前阿片类药物暴露对临床和非临床结果的影响，研究结果表明，阿片类药物暴露与较差的术后结果有关。有待解决的一个关键问题是，术前减少阿片类药物剂量是否以及在多大程度上能减轻术后的这些风险。
The Association of Preoperative Opioid Use with Postdischarge Outcomes: A Cohort Study of the Michigan Surgical Quality Collaborative.
Objective: To examine the association of prescription opioid fills over the year before surgery with postoperative outcomes.
Background: Nearly one-third of patients report opioid use in the year preceding surgery, yet an understanding of how opioid exposure influences patient-reported outcomes after surgery remains incomplete. Therefore, this study was designed to test the hypothesis that preoperative opioid exposure may impede recovery in the postoperative period.
Methods: This retrospective cohort study used a statewide clinical registry from 70 hospitals linked to opioid fulfillment data from the state's prescription drug monitoring program to categorize patients' preoperative opioid exposure as none (naïve), minimal, intermittent, or chronic. Outcomes were patient-reported pain intensity (primary), as well as 30-day clinical and patient-reported outcomes (secondary).
Results: Compared with opioid-naïve patients, opioid exposure was associated with higher reported pain scores at 30 days after surgery. Predicted probabilities were higher among the opioid exposed versus naive group for reporting moderate pain [43.5% (95% CI: 42.6%-44.4%) vs 39.3% (95% CI: 38.5%-40.1%)] and severe pain [13.% (95% CI: 12.5%-14.0%) vs 10.0% (95% CI: 9.5%-10.5%)], and increasing probability was associated increased opioid exposure for both outcomes. Clinical outcomes (incidence of emergency department visits, readmissions, and reoperation within 30 days) and patient-reported outcomes (reported satisfaction, regret, and quality of life) were also worse with increasing preoperative opioid exposure for most outcomes.
Conclusions: This study is the first to examine the effect of presurgical opioid exposure on both clinical and nonclinical outcomes in a broad cohort of patients and shows that exposure is associated with worse postsurgical outcomes. A key question to be addressed is whether and to what extent opioid tapering before surgery mitigates these risks after surgery.
期刊介绍：
The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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