D. Yun1, M. A. Plymale1, D. R. Oyler1, S. S. Slavova1, D. L. Davenport1, J. S. Roth1 1University Of Kentucky, College Of Medicine, Lexington, KY, USA
Introduction:
Previous research has shown nearly 1 in 2 ventral and incisional hernia repair (VIHR) patients have preoperative opioid use within a year before procedure. Development of new persistent opioid use after surgery is a valid concern, and the influence of preoperative opioid dose is not well known. The purpose of the study was to investigate the impact of preoperative opioid dose on postoperative opioid dose in a VIHR population.
Methods:
With IRB approval, a retrospective review of patient medical records was conducted on open VIHR consecutive cases (CPT codes: 49560, 49561, 49565, 49566) performed from August 2013 to July 2017 at a single institution. Kentucky All Schedule Prescription Electronic Reporting (KASPER) database was queried to obtain both preoperative and postoperative opioid use, dose, and prescription length. Preoperative opioid use was defined utilizing the CDC standard of any opioid use within 45 days prior to surgery, but data up to 90 days pre-admission and post-discharge was also analyzed. Morphine milligram equivalent (MME) was used for uniform comparison of dose among different prescriptions.
Results:
There were 235 patients who underwent VIHR during 2013 to 2017, and among them, 205 patients had KASPER record to extract opioid utilization data. Average age was 53.5 ± SD 12.0, and 50.7% were female. Over 35% met the criteria for preoperative opioid use, and the average MME level of 45 days in that group was 13.9 MME (90 day 14.1 MME). Among all patients, the postoperative 14-day opioid MME level was 693 (Opioid users 937, Opioid naïve 558, p < .001). Average 45-day MME of preoperative opioid correlated strongly with average 45-day MME of postoperative opioid use in patients who had mean ≥ 15 preoperative MME (r = .48, p< .001) but there was no correlation in patients with mean preop MME < 15 (r = .05, p = .643). 90-day MME of preoperative opioid also correlated significantly with 90-day postoperative MME (r = .673, p <.001).
Conclusion:
Preoperative opioid dose over both 45 and 90 days correlated strongly with postoperative opioid dose over the same timeframes for higher preoperative MME VIHR patients. Patients with average ≥ 15 MME 45-day preoperative opioid were likely to continue use at a similar level postoperatively, while lower MME patients were more arbitrary in their postoperative use. Further research exploring the indications of preoperative opioid use and its impact on postoperative opioid use in VIHR patients is needed.
