Screening, Proactive Intervention to Achieve
A study from the University of Michigan Institute for Healthcare Policy and Innovation recommends that doctors should determine if their patients who are scheduled for elective abdominal surgery are already taking opioids. The study found that these patients experienced longer hospital stays and required more extensive follow-up care than other surgical candidates who were not taking opioids. This can translate to postsurgical costs that are double or triple in amount, prompting the recommendation that presurgical opioid use should be considered a preoperative risk factor. Lead author Jennifer Waljee, MD, MS, summarized, “We often pause when we are considering elective surgery with a patient, based on known risk factors such as smoking, anticoagulant use, and overall medical conditions. These findings suggest that perhaps preoperative opioid use warrants the same awareness.” The findings are published in the journal Annals of Surgery.
Management options for these patients could include the initiation of opioid tapering and the engagement of alternative modalities for pain management, according to the study. In addition, the authors warn that preoperative opioid use may have resulted in heightened opioid tolerance, making these patients more vulnerable postsurgery. The study examined records of more than 200,000 patients who underwent common procedures including hysterectomies, bariatric surgery, hernia repair, and reflux surgery and that involved at least 1 night of hospital stay. 9% of these had received at least 2 prescriptions for opioids within 90 days before their surgery, and this cohort spent an additional ½ day in the hospital, and were more likely to return to the hospital or to a rehabilitation facility in the first 30 days after surgery.
A news story about the study conclusions may be read here.
The journal abstract may be read here.
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