Ryan Howard1, Jeremy Albright2, Michael Englesbe1, Nicholas Osborne3, Peter Henke4. 1. Department of Surgery, University of Michigan, Ann Arbor, Michigan. 2. Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan. 3. Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan. 4. Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: henke@med.umich.edu.
Abstract
OBJECTIVE: Opioid use is common among patients with peripheral arterial disease (PAD), given that pain is a defining symptom. Unfortunately, long-term opioid use places patients at dramatically increased risk of overdose and death. Although surgical revascularization is extremely effective in alleviating ischemic pain related to PAD, it is unclear whether this practice results in the discontinuation of opioids after surgery. Therefore, we conducted the following study to investigate trends in opioid use before and after surgical bypass in patients with PAD, as well as the risk factors for continued opioid use after surgery. METHODS: We conducted a retrospective analysis of patients undergoing open lower extremity bypass for claudication or rest pain between June 1, 2017, and March 31, 2021. Patients were grouped according to whether they reported preoperative opioid use at the time of surgery. The primary outcome was continued opioid use at 30-day follow-up after discharge. A multivariable logistic regression was conducted to estimate the association of continued opioid use with patient characteristics, preoperative opioid use, and receiving a postoperative opioid prescription. RESULTS: Among 3873 patients undergoing surgery, the mean age was 65.7 (10.2) years and 2650 (68.4%) patients were male. There were 913 patients (23.6%) who used opioids preoperatively and hydrocodone was the most common preoperative opioid (583 [63.9%]). At discharge, 2506 patients (64.7%) received a postoperative opioid prescription. Postoperative opioid prescriptions were significantly more common for preoperative opioid users than opioid-naïve patients (813 [89.0%] vs 1693 [57.2%]; P < .001) and were significantly larger in size (24.3 [21.1] pills vs 19.9 [10.5] pills; P < .001). On 30-day follow-up, 522 preoperative opioid users (61.3%) and 616 opioid-naïve patients (28.4%) reported that they were still using opioids (P < .001). Continued opioid use at follow-up was associated with preoperative opioid use (adjusted odds ratio, 3.23; 95% confidence interval, 2.70-3.89) and receiving a postoperative opioid prescription (adjusted odds ratio, 10.83; 95% confidence interval, 7.96-15.06). CONCLUSIONS: Most patients with PAD who use opioids preoperatively do not discontinue opioids after lower extremity bypass. Moreover, a significant proportion of previously opioid-naïve patients are still using opioids 1 month after surgery. In both cases, postoperative opioid prescriptions had the strongest association with continued opioid use. These findings underscore the need for improved prescribing practice and increased attentiveness to discontinuation of unnecessary medications after surgery.
OBJECTIVE: Opioid use is common among patients with peripheral arterial disease (PAD), given that pain is a defining symptom. Unfortunately, long-term opioid use places patients at dramatically increased risk of overdose and death. Although surgical revascularization is extremely effective in alleviating ischemic pain related to PAD, it is unclear whether this practice results in the discontinuation of opioids after surgery. Therefore, we conducted the following study to investigate trends in opioid use before and after surgical bypass in patients with PAD, as well as the risk factors for continued opioid use after surgery. METHODS: We conducted a retrospective analysis of patients undergoing open lower extremity bypass for claudication or rest pain between June 1, 2017, and March 31, 2021. Patients were grouped according to whether they reported preoperative opioid use at the time of surgery. The primary outcome was continued opioid use at 30-day follow-up after discharge. A multivariable logistic regression was conducted to estimate the association of continued opioid use with patient characteristics, preoperative opioid use, and receiving a postoperative opioid prescription. RESULTS: Among 3873 patients undergoing surgery, the mean age was 65.7 (10.2) years and 2650 (68.4%) patients were male. There were 913 patients (23.6%) who used opioids preoperatively and hydrocodone was the most common preoperative opioid (583 [63.9%]). At discharge, 2506 patients (64.7%) received a postoperative opioid prescription. Postoperative opioid prescriptions were significantly more common for preoperative opioid users than opioid-naïve patients (813 [89.0%] vs 1693 [57.2%]; P < .001) and were significantly larger in size (24.3 [21.1] pills vs 19.9 [10.5] pills; P < .001). On 30-day follow-up, 522 preoperative opioid users (61.3%) and 616 opioid-naïve patients (28.4%) reported that they were still using opioids (P < .001). Continued opioid use at follow-up was associated with preoperative opioid use (adjusted odds ratio, 3.23; 95% confidence interval, 2.70-3.89) and receiving a postoperative opioid prescription (adjusted odds ratio, 10.83; 95% confidence interval, 7.96-15.06). CONCLUSIONS: Most patients with PAD who use opioids preoperatively do not discontinue opioids after lower extremity bypass. Moreover, a significant proportion of previously opioid-naïve patients are still using opioids 1 month after surgery. In both cases, postoperative opioid prescriptions had the strongest association with continued opioid use. These findings underscore the need for improved prescribing practice and increased attentiveness to discontinuation of unnecessary medications after surgery.
Authors: Jessica P Simons; Philip P Goodney; Brian W Nolan; Jack L Cronenwett; Louis M Messina; Andres Schanzer Journal: J Vasc Surg Date: 2010-04-24 Impact factor: 4.268
Authors: Frank M Davis; Erin Jerzal; Jeremy Albright; Andris Kazmers; Ash Monsour; Paul Bove; Peter K Henke Journal: J Vasc Surg Date: 2019-03-02 Impact factor: 4.268
Authors: Katherine B Santosa; Hsou-Mei Hu; Chad M Brummett; Margaret A Olsen; Michael J Englesbe; Eva A Williams; Jennifer F Waljee Journal: Surgery Date: 2019-07-23 Impact factor: 3.982
Authors: Debabrata Mukherjee; Khan Munir; Alan T Hirsch; Stanley Chetcuti; Paul M Grossman; Sanjay Rajagopalan; Brahmajee K Nallamothu; Mauro Moscucci; Peter Henke; Elias Kassab; Chaman Sohal; Arthur Riba; Donna Person; Ann E Luciano; Michele DeGregorio; Kiritkumar Patel; Karen C Rutkowski; Kim A Eagle Journal: Am Heart J Date: 2005-06 Impact factor: 4.749
Authors: Damon C Scales; Hadas D Fischer; Ping Li; Arlene S Bierman; Olavo Fernandes; Muhammad Mamdani; Paula Rochon; David R Urbach; Chaim M Bell Journal: J Gen Intern Med Date: 2016-02 Impact factor: 5.128
Authors: Wendy C King; Jia-Yuh Chen; Steven H Belle; Anita P Courcoulas; Gregory F Dakin; Katherine A Elder; David R Flum; Marcelo W Hinojosa; James E Mitchell; Walter J Pories; Bruce M Wolfe; Susan Z Yanovski Journal: JAMA Date: 2016-04-05 Impact factor: 56.272