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Cited by 211Opioid Use Disorder TreatmentPain Management and Opioid UseAnesthesia and Pain Management

Prevalence of Preoperative Opioid Use and Characteristics Associated With Opioid Use Among Patients Presenting for Surgery

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Hilliard, Paul E., Waljee, Jennifer, Moser, Stephanie, Metz, Lynn, Mathis, Michael, Goesling, Jenna, Cron, David, Clauw, Daniel J. +3 more·2018·JAMA Surgery
DOI 10.1001/jamasurg.2018.2102PMC PMC6233789
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Abstract

Importance: Patterns of preoperative opioid use are not well characterized across different surgical services, and studies in this patient population have lacked important self-reported data of pain and affect. Objectives: To assess the prevalence of preoperative opioid use and the characteristics of these patients in a broadly representative surgical cohort. Design, Setting, and Participants: Cross-sectional, observational study of patients undergoing surgery at a tertiary care academic medical center. Data were collected as a part of large prospective institutional research registries from March 1, 2010, through April 30, 2016. Exposures: Preoperative patient and procedural characteristics, including prospectively assessed self-reported pain and functional measures. Main Outcomes and Measures: Patient-reported opioid use before surgery. Results: Of the total 34 186 patients recruited (54.2% women; mean [SD] age, 53.1 [16.1] years), preoperative opioid use was reported in 7894 (23.1%). The most common opioids used were hydrocodone bitartrate (4685 [59.4%]), tramadol hydrochloride (1677 [21.2%]), and oxycodone hydrochloride (1442 [18.3%]). Age of 31 to 40 years (adjusted odds ratio [aOR], 1.26; 95% CI, 1.10-1.45), tobacco use (former use aOR, 1.32 [95% CI, 1.22-1.42]; current use aOR, 1.62 [95% CI, 1.48-1.78]), illicit drug use (aOR, 1.74; 95% CI, 1.16-2.60), higher pain severity (aOR, 1.33; 95% CI, 1.31-1.35), depression (aOR, 1.22; 95% CI, 1.12-1.33), higher Fibromyalgia Survey scores (aOR, 1.06, 95% CI, 1.05-1.07), lower life satisfaction (aOR, 0.95, 95% CI, 0.93-0.96), and more medical comorbidities (American Society of Anesthesiology score aOR, 1.47 [95% CI, 1.37-1.58]; Charlson Comorbidity Index aOR, 1.29 [95% CI, 1.18-1.41]) were all independently associated with preoperative opioid use. Preoperative opioid use was most commonly reported by patients undergoing orthopedic (226 [65.1%]) and neurosurgical spinal (596 [55.1%]) procedures and least common among patients undergoing thoracic procedures (244 [15.7%]). After adjusting for patient characteristics, the patients undergoing lower extremity procedures were most likely to report preoperative opioid use (aOR, 3.61; 95% CI, 2.81-4.64), as well as those undergoing pelvic (excluding hip) (aOR, 3.09; 95% CI, 1.88-5.08), upper extremity (aOR, 3.07; 95% CI, 2.12-4.45), and spinal or spinal cord (aOR, 2.68; 95% CI, 2.15-3.32) procedures, with the group undergoing intrathoracic surgery as the reference group. Conclusions and Relevance: In this large study of preoperative opioid use that includes patient-reported outcome measures, more than 1 in 4 patients presenting for surgery reported opioid use. These data provide important insights into this complicated patient population that would appear to help guide future preoperative optimization and perioperative opioid-weaning interventions.

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  1. [21]21. Goesling J, Moser SE, Zaidi B, et al. Trends and predictors of opioid use after total knee and total hip arthroplasty. Pain. 2016;157(6):1259-1265. doi:10.1097/j.pain.0000000000000516 · DOI · Paper page

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Authors
Hilliard, P. E., Waljee, J., Moser, S., Metz, L., Mathis, M., Goesling, J., Cron, D., Clauw, D. J., Englesbe, M., Abecasis, G., & Brummett, C. M.
Affiliations
  • Michigan Medicine (US)
  • University of Michigan (US)
  • School of Public Health, University of Michigan Health System, Ann Arbor
Corresponding author
Hilliard, Paul E.
ORCID
Venue
JAMA Surgery
Publisher
American Medical Association (AMA)
Published
2018-10-01
Volume
153
Issue
10
Pages
929
ISSN
2168-6254 (ISSN-L)
DOI
10.1001/jamasurg.2018.2102
PMC
PMC6233789
OpenAlex
W2839544681
Semantic Scholar
9b913b00bd99b6745e3a338388f522a4a1d86389
Cited by
211
References
37
Citations by year
2026: 15 · 2025: 20 · 2024: 25 · 2023: 32 · 2022: 20 · 2021: 35 · 2020: 34 · 2019: 26 · 2018: 4
FWCI
23.56
Type
journal article
Language
en
Open access
Locations
  • JAMA Surgery (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Agency for Healthcare Research and Quality (K08HS023313)
  • National Institute on Drug Abuse (K23DA038718, R01DA038261, R01DA042859)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (P50AR070600)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
Keywords
preoperative opioid use, opioid prescribing, surgical patients, hydrocodone, tramadol, oxycodone, tobacco use, illicit drug use, depression, fibromyalgia, life satisfaction, pain intensity, comorbidities, patient-reported outcomes, surgical outcomes
MeSH terms
Patient Reported Outcome Measures, Analgesics, Opioid, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Pain, Preoperative Care, Prospective Studies, Thoracic Surgical Procedures, Neurosurgical Procedures, Orthopedic Procedures, Tertiary Care Centers

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