T. A. Holeman1, 3, M. J. Buys4, 5, K. Bayless5, Z. Anderson5, J. Beckstrom1, 2, B. S. Brooke1, 2, 3 1University Of Utah, Department Of Surgery, Salt Lake City, UT, USA 2VA Salt Lake City Health Care System, Department Of Surgery, Salt Lake City, UT, USA 3University of Utah, Department Of Population Heath Sciences, SALT LAKE CITY, UT, USA 4University Of Utah, Department Of Anesthesiology, Salt Lake City, UT, USA 5VA Salt Lake City Health Care System, Department Of Anesthesiology, Salt Lake City, UT, USA
Introduction: Preoperative opioid use is common, and efforts to taper patients off opioids after surgery are promoted to prevent long-term health effects of misuse. However, it is unclear whether complete opioid tapering can be achieved among chronic opioid users (COU) without adversely impacting their pain control and quality of life. This study was designed to assess the association between complete opioid tapering following surgery and patient-reported outcome measures (PROMs) for pain intensity and pain interference with activities of daily living.
Methods: We identified patients with COU undergoing a spectrum of non-emergent orthopedic, vascular, and general surgery procedures at a single VA medical institution between December 2017 and December 2020. All patients were prospectively followed by a transitional pain service (TPS) for 90-days after surgery that promoted opioid tapering as well as assessed opioid use [milligram morphine equivalents (MME)] and PROMs of pain intensity (PROMIS P3A) and pain interference (PROMIS P6B). Pearson correlation coefficients were used to determine the relationship between PROMs and MME. Additionally, patients were stratified on whether complete vs. partial/no opioid tapering was achieved after surgery. Changes in PROMs were compared using analysis of variance (2-way ANOVA) and differences in effect size (Cohen’s d).
Results: 261 surgical patients (90% male with a mean age of 62.4 +/- 14.4 years) with COU underwent surgery at a VA medical center during the study period, of which 65 (25%) completely tapered off opioids within 60-days after surgery and 196 (75%) partially tapered or did not taper. Overall, there was a positive but low correlation between the change in MME and change in self-reported pain intensity (r=0.25, p<0.001) and pain interference (r=0.27, p<0.001). However, higher correlation coefficients were reported within the first 30-days after discharge. After stratifying based on 60-day cessation status, there was no difference in baseline patient-reported intensity or interference between groups (p=0.32, 0.94 respectively). However, patients who completely tapered had significant improvement in the change in PROMS for pain intensity and interference (ANOVA, p<0.05, Figure A & B) with the most significant effect size at 30-days after discharge or both pain intensity and interference (Cohen’s d, 0.41 and 0.59, respectively).
Conclusion: Complete opioid tapering can be successfully achieved following surgery among patients with COU without adversely impacting self-reported pain intensity or pain interference. Our results suggest that the highest potential for improving these PROMs with opioid tapering occurs within the first 30-days after discharge.
