Factors associated with home opioid use after thoracic surgeryCentral MessagePerspective
Jeffrey D. Hodges, MD, MS,
Duc T. Nguyen, MD, PhD,
Jane Doan, MPA,
Leonora M. Meisenbach, DNP, RN, ACNP-BC,
Ray Chihara, MD, PhD,
Edward Y. Chan, MD, FACS,
Edward A. Graviss, PhD, MPH, FIDSA,
Min P. Kim, MD, FACS
Affiliations
Jeffrey D. Hodges, MD, MS
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex
Duc T. Nguyen, MD, PhD
Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Tex
Jane Doan, MPA
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex
Leonora M. Meisenbach, DNP, RN, ACNP-BC
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex
Ray Chihara, MD, PhD
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex; Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Tex
Edward Y. Chan, MD, FACS
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex; Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Tex
Edward A. Graviss, PhD, MPH, FIDSA
Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Tex
Min P. Kim, MD, FACS
Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex; Department of Surgery and Cardiothoracic Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Tex; Address for reprints: Min P. Kim, MD, FACS, 6550 Fannin St, Suite 1661, Houston, TX 77030.
Objective: Enhanced recovery after surgery (ERAS) with a pre-emptive pain management program has been shown to decrease opioid prescriptions after thoracic surgery. We sought to determine which patient or procedural factors were associated with the need for prescription opioid medications after thoracic surgical procedures. Methods: We performed a retrospective analysis of a postoperative pain survey at the time of follow-up in combination with procedural and patient characteristic data. We then performed univariate and multivariate logistic regression to determine factors associated with prescription opioids use. Results: Two hundred twenty-eight patients completed questionnaires at a median of 37 days after surgery. Most patients received minimally invasive surgery (n = 213, 93%) with the 2 most common types of operations being foregut (n = 92, 40%) and pulmonary resection (n = 80, 35%). Thirty-nine percent of patients (n = 89) were taking chronic pain medications preoperatively, with 15% on chronic opioids medication (n = 33). After surgery, 166 patients (72%) did not take opioids at home. Multivariate analysis showed any chronic opioid medications before surgery (odds ratio, 28.8; 95% confidence interval, 9.13-90.8, P < .001) were associated with opioid use postoperatively. In contrast, increase in age was associated with a decrease in opioid use (odds ratio, 0.96; 95% confidence interval, 0.93-0.99, P = .01). Conclusions: ERAS with pre-emptive pain management was associated with patients avoiding opioid prescriptions during recovery. The patient factor of preoperative opioid pain medication(s) and younger age is a significant factor for the patient needing opioids at home after surgery instead of procedural factors. Patient characteristics should be considered when tailoring the patient's pain management after thoracic surgical procedures.
