Irene Rozet1, Isuta Nishio, Reinette Robbertze, Douglas Rotter, Howard Chansky, Adrian V Hernandez. 1. From the *Department of Anesthesiology and Pain Medicine, University of Washington; †Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington; and ‡Department of Quantitative Health Sciences, Health Outcomes and Clinical Epidemiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
BACKGROUND: Chronic postoperative pain occurs with an appreciable incidence after elective surgery. Known risk factors include perioperative pain and posttraumatic stress disorder (PTSD). Military veterans are a population at particular risk for PTSD and hence may be at increased risk for chronic pain after surgery. Our goal was to identify risk factors for chronic postoperative pain in young veterans after minor elective surgery, including the contribution of PTSD. METHODS: We reviewed the medical and pharmacy records of veterans (18-50 years old), undergoing elective knee arthroscopy from 2007 to 2010 at the Veteran's Administration Puget Sound Health Care System. The data included demographics, ASA physical status class, comorbidities, anesthesia medications, and opioid prescriptions starting 3.5 months before surgery and ending 3.5 months after surgery. We documented the presence of PTSD based on either the patient's problem list or the clinical notes. We used prolonged postoperative opioid prescription longer than 3 months after surgery as a surrogate for chronic postoperative pain. RESULTS: We identified 145 patients who met inclusion criteria. The median age was 39 ± 8 years old. Eighty-seven percent of the patients were men. The prevalence of PTSD was 32% (95% confidence interval, 25%-41%). PTSD was associated with increased incidence of smoking (P = 0.009) and preoperative opioid use (P = 0.0006). Preoperative opioids were prescribed in 44% (63 of 145) of the patients: in 64% (30 of 47) of patients with PTSD, compared with 34% (33 of 98) in patients without PTSD (P = .0006). Chronic postoperative pain was identified in 30% (43 of 145) of patients. The strongest independent predictor of chronic postoperative pain was an opioid prescription before surgery (odds ratio = 65.3; 95% confidence interval, 014.5-293.0). In patients older than 27.5 years who did not receive opioids before surgery, PTSD may also have been a risk factor for chronic postoperative pain. CONCLUSIONS: This single-center retrospective study suggests that the most important predictor of chronic postoperative pain is preoperative opioid use. For patients not taking opioids preoperatively, PTSD may increase the risk of prolonged postoperative opioid prescriptions and chronic postoperative pain, potentially related to patient age.
BACKGROUND:Chronic postoperative pain occurs with an appreciable incidence after elective surgery. Known risk factors include perioperative pain and posttraumatic stress disorder (PTSD). Military veterans are a population at particular risk for PTSD and hence may be at increased risk for chronic pain after surgery. Our goal was to identify risk factors for chronic postoperative pain in young veterans after minor elective surgery, including the contribution of PTSD. METHODS: We reviewed the medical and pharmacy records of veterans (18-50 years old), undergoing elective knee arthroscopy from 2007 to 2010 at the Veteran's Administration Puget Sound Health Care System. The data included demographics, ASA physical status class, comorbidities, anesthesia medications, and opioid prescriptions starting 3.5 months before surgery and ending 3.5 months after surgery. We documented the presence of PTSD based on either the patient's problem list or the clinical notes. We used prolonged postoperative opioid prescription longer than 3 months after surgery as a surrogate for chronic postoperative pain. RESULTS: We identified 145 patients who met inclusion criteria. The median age was 39 ± 8 years old. Eighty-seven percent of the patients were men. The prevalence of PTSD was 32% (95% confidence interval, 25%-41%). PTSD was associated with increased incidence of smoking (P = 0.009) and preoperative opioid use (P = 0.0006). Preoperative opioids were prescribed in 44% (63 of 145) of the patients: in 64% (30 of 47) of patients with PTSD, compared with 34% (33 of 98) in patients without PTSD (P = .0006). Chronic postoperative pain was identified in 30% (43 of 145) of patients. The strongest independent predictor of chronic postoperative pain was an opioid prescription before surgery (odds ratio = 65.3; 95% confidence interval, 014.5-293.0). In patients older than 27.5 years who did not receive opioids before surgery, PTSD may also have been a risk factor for chronic postoperative pain. CONCLUSIONS: This single-center retrospective study suggests that the most important predictor of chronic postoperative pain is preoperative opioid use. For patients not taking opioids preoperatively, PTSD may increase the risk of prolonged postoperative opioid prescriptions and chronic postoperative pain, potentially related to patient age.
Authors: Ruchir N Karmali; Christopher Bush; Sudha R Raman; Cynthia I Campbell; Asheley C Skinner; Andrew W Roberts Journal: Pharmacoepidemiol Drug Saf Date: 2019-12-18 Impact factor: 2.890
Authors: Hannah Wunsch; Andrea D Hill; Longdi Fu; Rob A Fowler; Han Ting Wang; Tara Gomes; Eddy Fan; David N Juurlink; Ruxandra Pinto; Duminda N Wijeysundera; Damon C Scales Journal: Am J Respir Crit Care Med Date: 2020-08-15 Impact factor: 21.405
Authors: W Michael Hooten; Jennifer L St Sauver; Michaela E McGree; Debra J Jacobson; David O Warner Journal: Mayo Clin Proc Date: 2015-07 Impact factor: 7.616
Authors: Daniel Cunningham; Brian Lewis; Carolyn Hutyra; Shane Nho; Steven Olson; Richard Mather Journal: Arthroscopy Date: 2018-02-02 Impact factor: 4.772
Authors: Naheed K Jivraj; Faizal Raghavji; Jennifer Bethell; Duminda N Wijeysundera; Karim S Ladha; Brian T Bateman; Mark D Neuman; Hannah Wunsch Journal: Anesthesiology Date: 2020-06 Impact factor: 7.892
Authors: Paul E Hilliard; Jennifer Waljee; Stephanie Moser; Lynn Metz; Michael Mathis; Jenna Goesling; David Cron; Daniel J Clauw; Michael Englesbe; Goncalo Abecasis; Chad M Brummett Journal: JAMA Surg Date: 2018-10-01 Impact factor: 14.766
Authors: Michael T Scott; Allison L Boden; Stephanie A Boden; Lauren M Boden; Kevin X Farley; Michael B Gottschalk Journal: Hand (N Y) Date: 2020-04-01