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Pain Med. 2016 Sep;17(9):1732-43. doi: 10.1093/pm/pnw015. Epub 2016 Apr 15.

Time-to-Cessation of Postoperative Opioids: A Population-Level Analysis of the Veterans Affairs Health Care System.

Author information

1
*Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California mudumbai@stanford.edu.
2
Program Evaluation and Resource Center; and Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
3
Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts.
4
*Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California.
5
Department of Medicine, Stanford University School of Medicine, Stanford, California, Health Economics Resource Center, Menlo Park, California; Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Palo Alto, California; and Department of Health Research and Policy, Stanford University, Stanford, California, USA.

Abstract

OBJECTIVE:

This study aims to determine 1) the epidemiology of perioperative opioid use; and 2) the association between patterns of preoperative opioid use and time-to-cessation of postoperative opioids.

DESIGN:

Retrospective, cohort study.

SETTING:

National, population-level study of Veterans Healthcare Administration (VHA) electronic clinical data.

SUBJECTS:

All VHA patients (n = 64,391) who underwent surgery in 2011, discharged after stays of ≥1 day, and receiving ≥1 opioid prescription within 90 days of discharge.

METHODS:

Patients' preoperative opioid use were categorized as 1) no opioids, 2) tramadol only, 3) short-acting (SA) acute/intermittent (≤ 90 days fill), 4) SA chronic (> 90 days fill), or 5) any long-acting (LA). After defining cessation as 90 consecutive, opioid-free days, the authors calculated time-to-opioid-cessation (in days), from day 1 to day 365, after hospital discharge. The authors developed extended Cox regression models with a priori identified predictors. Sensitivity analyses used alternative cessation definitions (30 or 180 consecutive days).

RESULTS:

Almost 60% of the patients received preoperative opioids: tramadol (7.5%), SA acute/intermittent (24.1%), SA chronic (17.5%), and LA (5.2%). For patients opioid-free preoperatively, median time-to-cessation of opioids postoperatively was 15 days. The SA acute/intermittent cohort (HR =1.96; 95% CI =1.92-2.00) had greater risk for prolonged time-to-cessation than those opioid-free (reference), but lower risk than those taking tramadol only, SA chronic (HR = 9.09; 95% CI = 8.33-9.09), or LA opioids (HR = 9.09; 95% CI = 8.33-10.00). Diagnoses of chronic pain, substance-use, or affective disorders were weaker positive predictors. Sensitivity analyses maintained findings.

CONCLUSION:

Greater preoperative levels of opioid use were associated with progressively longer time-to-cessation postoperatively.

KEYWORDS:

Cessation; Long-Acting Opioids; Perioperative; Pharmacoepidemiology; Short-Acting Opioids; Surgery

PMID:
27084410
DOI:
10.1093/pm/pnw015
[Indexed for MEDLINE]

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