Determinants of time to opioid cessation post-surgery

Various elements may contribute to a patient’s time to opioid cessation post-surgery. We investigated this in an ongoing study comparing the effects of gabapentin versus placebo given before and after surgery. This study follows participants undergoing mastectomy, lumpectomy, thoracotomy, knee replacement, hip replacement, or video-assisted thoracoscopic surgery. We hypothesized that opioid use and depression before surgery would increase the time until opioid cessation. Prior to surgery, participants completed a baseline questionnaire assessing psychological state and opioid use. Following surgery, we collected daily data on opioid consumption and pain from participants via phone assessment until opioid cessation, surgical pain cessation, and full recovery from surgery. Thus far, we have analyzed seven characteristics with regard to opioid cessation in 121 participants. Of these, gender, preoperative opioid use, and depressive symptoms had a statistically significant correlation (p<0.05). In a multivariate analysis, participants scoring in the 75th percentile of the Beck Depression Inventory II (BDI-II) had a 74% (95% CI 0.55-0.98; P=0.03) reduction in the rate of opioid cessation following surgery compared to the 25th percentile, and preoperative opioid use was associated with a 61% (95% CI 0.20-0.78; p=0.002) reduction in the rate of opioid cessation. Gender was no longer significant (p=0.09); however, this may demonstrate that gender is correlated with BDI-II score or previous opioid use. These results are in agreement with the results from Carroll, et. al.’s study¹ and show that preoperative factors, particularly depressive symptoms and opioid use before surgery, are indicative of time to opioid cessation after surgery. Further analysis of this subject could improve our understanding of chronic opioid use and guide post-surgical pain prescription practices. (1. Carroll, Ian, et. al., A Pilot Cohort Study of the Determinants of Longitudinal Opioid Use After Surgery, 2012.)