A pilot cohort study of the determinants of longitudinal opioid use after surgery.
BACKGROUND
Determinants of the duration of opioid use after surgery have not been reported. We hypothesized that both preoperative psychological distress and substance abuse would predict more prolonged opioid use after surgery.


METHODS
Between January 2007 and April 2009, a prospective, longitudinal inception cohort study enrolled 109 of 134 consecutively approached patients undergoing mastectomy, lumpectomy, thoracotomy, total knee replacement, or total hip replacement. We measured preoperative psychological distress and substance use, and then measured the daily use of opioids until patients reported the cessation of both opioid consumption and pain. The primary end point was time to opioid cessation. All analyses were controlled for the type of surgery done.


RESULTS
Overall, 6% of patients continued on new opioids 150 days after surgery. Preoperative prescribed opioid use, depressive symptoms, and increased self-perceived risk of addiction were each independently associated with more prolonged opioid use. Preoperative prescribed opioid use was associated with a 73% (95% confidence interval [CI] 0.51%-87%) reduction in the rate of opioid cessation after surgery (P = 0.0009). Additionally, each 1-point increase (on a 4-point scale) of self-perceived risk of addiction was associated with a 53% (95% CI 23%-71%) reduction in the rate of opioid cessation (P = 0.003). Independent of preoperative opioid use and self-perceived risk of addiction, each 10-point increase on a preoperative Beck Depression Inventory II was associated with a 42% (95% CI 18%-58%) reduction in the rate of opioid cessation (P = 0.002). The variance in the duration of postoperative opioid use was better predicted by preoperative prescribed opioid use, self-perceived risk of addiction, and depressive symptoms than postoperative pain duration or severity.


CONCLUSIONS
Preoperative factors, including legitimate prescribed opioid use, self-perceived risk of addiction, and depressive symptoms each independently predicted more prolonged opioid use after surgery. Each of these factors was a better predictor of prolonged opioid use than postoperative pain duration or severity.
Department of Anesthesia, Division of Pain Management, Stanford University, Palo Alto, CA 94035, USA. irc39@pain.stanford.edu
Ian
I
Carroll
Peter
P
Barelka
Charlie Kiat Meng
CK
Wang
Bing Mei
BM
Wang
Matthew John
MJ
Gillespie
Rebecca
R
McCue
Jarred W
JW
Younger
Jodie
J
Trafton
Keith
K
Humphreys
Stuart B
SB
Goodman
Fredrick
F
Dirbas
Richard I
RI
Whyte
Jessica S
JS
Donington
Walter B
WB
Cannon
Sean Charles
SC
Mackey
D000328:Adult; D000339:Affect; D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015331:Cohort Studies; D003863:Depression / Q000503:physiopathology; D005239:Fear; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009293:Opioid-Related Disorders / Q000209:etiology*; D010149:Postoperative Pain / Q000188:drug therapy*; D010865:Pilot Projects; D012649:Self Concept; D013997:Time Factors
D000701:Analgesics, Opioid