Perioperative Celecoxib and Postoperative Opioid Use in Hand Surgery: A Prospective Cohort Study

Abstract INTRODUCTION The opioid crisis is a national emergency. We conducted a prospective cohort study to determine whether elective spine surgery can be performed without any opioids whatsoever. METHODS Every consecutive elective spine surgery performed by author R.A.B. between January 1st and December 31st of 2018 was included. For cohort A, between January and April 15th, opioids were minimized but PRN doses were given. For cohort B, between April 15th and December, the goal was to eliminate opioids altogether. Pain scores were collected at discharge, 1 wk, and 1-mo follow-up. Patient-reported outcomes (PRO) were collected at baseline and at 3 mo for lumbar procedures. Emergency room visits and readmissions were tracked. Student's t-tests were used to compare pain scores and PROs, and multivariate regression analyses were performed to understand drivers of opioid use. RESULTS A total of 158 patients were included. In cohort A, 37.9% of patients took no opioids between PACU and 1 mo. Average pain scores were 5.2 in PACU and 2.5 at 1 mo. In cohort B, 86.7% took no opioids after PACU. Average pain scores were 4.2 in PACU and 2.5 at 1 mo. Both cohorts had equivalent improvements in PROs. Multivariate regression revealed that, adjusting for case mix differences, cohort B had lower odds of opioid use after PACU (P < .0001). Moreover, preoperative opioid use is a driver of postoperative opioid use (P = .02), whereas procedure type/invasiveness is not. CONCLUSION We have shown that opioid-free spine surgery, including lumbar fusions, is feasible and effective. In all 87% of patients in our opioid-elimination cohort took no opioids from PACU until 1 mo after surgery, and 94% were taking none at the 1-mo visit. Pain scores and PROs were favorable. We have also shown that preoperative opioids are a driver of postoperative opioid use, however procedural invasiveness is not.

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Predictors of relapse in the early stages of the treatment among inpatients with opioid use disorder: A single-center, prospective cohort study

Psychiatry and Clinical Psychopharmacology ◽

10.5455/pcp.20200302044600 ◽

2020 ◽

Vol 30 (3) ◽

pp. 1

Author(s):

Sakir Gica ◽

Zeliha Donmez ◽

Basak Unubol ◽

M Iyisoy ◽

Huseyin Gulec

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Opioid Use Disorder ◽

Single Center ◽

Opioid Use ◽

Early Stages

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Post-discharge opioid use and handling in surgical patients: A multicentre prospective cohort study

Anaesthesia and Intensive Care ◽

10.1177/0310057x19895019 ◽

2020 ◽

Vol 48 (1) ◽

pp. 36-42 ◽

Cited By ~ 2

Author(s):

Megan L Allen ◽

Charles C Kim ◽

Sabine Braat ◽

Karin Jones ◽

Noam Winter ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Surgical Patients ◽

Opioid Use ◽

Post Discharge ◽

Opioid Medication ◽

Post Surgery ◽

Opioid Medications

Our aim was to determine the frequency and characteristics of post-surgery prescription of opioid medication and to describe patients’ handling of discharge opioid medications. We performed a multicentre prospective cohort study of adult patients undergoing elective or emergency surgery with a postoperative stay of one or more nights, with phone follow-up at two weeks after hospital discharge. The main outcome measures included the proportion of patients prescribed discharge opioid medications, post-discharge opioid use, opioid storage and disposal. Of the 1450 eligible surgical patients, opioids were dispensed on discharge to 858 (59%, 95% confidence interval (CI) (57%–62%)), with immediate-release oxycodone the most common medication. Of the 581 patients who were discharged with opioid medication and completed follow-up, 27% were still requiring opioids two weeks after discharge. Post-discharge opioid consumption was highly variable in the study cohort. The majority (70%) of patients had leftover opioids and only a small proportion (5%) reported disposal of the surplus. In a multivariate model, patients with characteristics of age 45 years or less (odds ratio, OR = 1.78, 95% CI (1.36–2.33) versus older than 45 years), American Society of Anesthesiologists’ physical status (ASA) scores of 1 or 2 (OR = 1.96, 95% CI (1.52–2.53) versus ASA score 3 to 5), higher anticipated surgical pain (OR = 1.45, 95% CI (1.08–1.94) severe versus moderate, OR = 17.48, 95% CI (5.79–52.69) severe versus nil/mild) and public funding status (OR = 1.89, 95% CI (1.36–2.64) versus other) were more likely ( P < 0.001) to receive discharge opioids. Post-surgery prescription of opioids is common and supply is often excessive. Post-discharge opioid handling included suboptimal storage and disposal.

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