PERSISTENT OPIOID USE AFTER CURATIVE-INTENT HEPATECTOMY FOR NEOPLASTIC DISEASE
Tracey Pu*1, Richard A. Erali1, Michael Share1, Gregory B. Russell2, Clancy J. Clark1, Edward Levine1, Perry Shen1
1Department of Surgical Oncology, Wake Forest School of Medicine, Winston-Salem, NC; 2Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
Intro
Chronic narcotic addiction can occur in patients given opioids for postoperative pain after surgical procedures. Current practice emphasizes decreasing opioid exposure in perioperative pain management to reduce opioid-related deaths and addiction. This study analyzed the incidence of persistent opioid use in opioid-naïve and non-opioid-naïve patients undergoing hepatectomy for neoplastic disease.
Methods
A retrospective review was performed of a prospective database using inclusion criteria of hepatectomy for neoplastic disease from October 2013 to December 2017. Opioid prescription data was collected from the North Carolina Controlled Substance Reporting System. Persistent opioid use was defined as patients who continued filling opioid prescriptions 90 days to 1 year after surgery. Patients who did not receive opioid prescriptions between 12 months and 31 days before surgery were defined as naïve. Repeated measures of analysis of variance was employed.
Results
Analysis included 86 surgeries on 79 naïve and 60 surgeries on 58 non-naïve patients. 57% of naïve patients and 80% of non-naïve patients developed persistent opioid use, respectively (p=0.014). There was no significant difference in daily median morphine milligram equivalents taken 90 days to 1 year post-hepatectomy between naïve and non-naïve groups with persistent opioid use (p=0.08). naïve patients with a lower pre-operative ECOG score were less likely to develop persistence opioid use (OR 0.46, 95% CI: 0.21-1.00; P=0.05). Non-naïve patients had an increased likelihood of persistent opioid use with each additional year of age at time of hepatectomy (OR 1.06, 95% CI: 1.01-1.12; P=0.026), while each additional day in hospital trended towards increased likelihood of persistent opioid use (OR 1.17, 95% CI: 0.99-1.38; P=0.067). Other factors such as BMI, gender, extent of hepatectomy, EBL, operative time, preoperative or adjuvant chemotherapy, use of regional anesthesia, and surgical approach (open versus laparoscopic) were not significantly associated with persistent opioid use in either group.
Conclusion
More than half of naïve patients undergoing hepatectomy developed persistent opioid use in the first year after surgery, though it was significantly less than non-naïve patients. Improved performance status was associated with decreased risk of persistent opioid use in naïve patients, while increasing age and length of stay were associated with persistent opioid use in non-naïve patients. Greater awareness of long-term opioid use and associated risk factors are important in improving narcotic prescribing practices for patients undergoing hepatectomy for neoplastic disease.
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