title: Factors Associated with Opioid Use in a Cohort of Patients Presenting for Surgery.
abstract: Objectives. Patients taking opioids prior to surgery experience prolonged postoperative opioid use, worse clinical outcomes, increased pain, and more postoperative complications. We aimed to compare preoperative opioid users to their opioid naïve counterparts to identify differences in baseline characteristics. Methods. 107 patients presenting for thoracotomy, total knee replacement, total hip replacement, radical mastectomy, and lumpectomy were investigated in a cross-sectional study to characterize the associations between measures of pain, substance use, abuse, addiction, sleep, and psychological measures (depressive symptoms, Posttraumatic Stress Disorder symptoms, somatic fear and anxiety, and fear of pain) with opioid use. Results. Every 9-point increase in the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) score was associated with 2.37 (95% CI 1.29-4.32) increased odds of preoperative opioid use (p = 0.0005). The SOAPP-R score was also associated with 3.02 (95% CI 1.36-6.70) increased odds of illicit preoperative opioid use (p = 0.007). Also, every 4-point increase in baseline pain at the future surgical site was associated with 2.85 (95% CI 1.12-7.27) increased odds of legitimate preoperative opioid use (p = 0.03). Discussion. Patients presenting with preoperative opioid use have higher SOAPP-R scores potentially indicating an increased risk for opioid misuse after surgery. In addition, legitimate preoperative opioid use is associated with preexisting pain.
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Hah
authors.affiliation: Stanford Systems Neuroscience and Pain Lab (SNAPL), Stanford University, Palo Alto, CA, USA.
authors.forename: Yasamin
authors.initials: Y
authors.lastname: Sharifzadeh
authors.affiliation: Stanford Systems Neuroscience and Pain Lab (SNAPL), Stanford University, Palo Alto, CA, USA.
authors.forename: Bing M
authors.initials: BM
authors.lastname: Wang
authors.affiliation: Stanford Systems Neuroscience and Pain Lab (SNAPL), Stanford University, Palo Alto, CA, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gillespie
authors.affiliation: Department of Orthopaedic Surgery, Stanford University, Palo Alto, CA, USA.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Goodman
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA.
authors.forename: Sean C
authors.initials: SC
authors.lastname: Mackey
authors.affiliation: Division of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Palo Alto, CA, USA.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Carroll