gms | German Medical Science

Background: Opioid analgesics are essential for managing postsurgical pain but can lead to persistent postoperative opioid use (PPOU). PPOU poses significant societal and health risks and was discussed to be the reason for the opioid crisis in the US. While preoperative, patient-specific risk factors contributing to PPOU have been identified, little is known regarding the role of perioperative clinical processes and patient-reported acute pain outcomes.

Objective: This study aimed to investigate perioperative risk-factors for PPOU that could possibly be controlled by clinicians.

Methods: A prospective cohort study was conducted that linked data of the clinical pain registry QUIPS with BARMER health claims data in the context of the LOPSTER-project (Innovation Fund, FKz 01VSF19019). Adult BARMER beneficiaries were included after inpatient surgery into the registry between 03.2020 and 03.2021 in 31 participating hospitals. The registry documents clinical processes of the surgery and perioperative pain management as well as patient-reported acute pain outcomes on the first postsurgical day. This data was then linked to patients’ claims data via a study pseudonym. PPOU was defined based on claims data as having an opioid prescription in the first 90 days after discharge AND an opioid prescription between days 91-180. Pre-existing risk-factors were partly identified from the registry and partly from the claims data (12 month period before surgery). The association of preoperative risk factors as well as perioperative risk factors with PPOU was investigated in logistic regression analysis. We report effects as average marginal means.

Results: 1,849 patients with linked data were included, of which 7.8% exhibited PPOU. Among pre-existing risk factors, preoperative opioid use was the strongest predictor of PPOU, increasing the risk by 33.5% (p<0.001). Other preoperative risk factors were higher age (0.2% per year, p<0.001), diagnosed depression (7.5%, p<0.001) and American Society of Anesthesiologists risk classification (4.9% per class level, p<0.001). Among perioperative processes, neither type of anesthesia nor use of regional anesthesia were significant. Application of perioperative opioids was associated with an increased risk of PPOU by 4% (p=0.001). Maximal pain intensity (reported by the patient) increased the risk of PPOU by 0.5% (p<0.05) per level on the Numeric Rating Scale (0=no pain to 10=worst pain imaginable).

Implication for research and/or (healthcare) practice: While replicating findings regarding pre-existing risk-factors, this study extends our knowledge on the role of acute pain experience and perioperative pain management for the risk of PPOU. Although it should be noted that PPOU is not necessarily associated with a misuse of opioids, our findings emphasize the importance of careful perioperative opioid management to mitigate PPOU risks.

Funding: Innovationsfonds/Versorgungsforschung; Project name: LOPSTER; Grant number: 01VSF19019