F. Samaan1, A. Zil-E-Ali2, B. Alamarie1, A. Paracha1, N. Nwaneri1, F. Aziz2 1Penn State University College Of Medicine, Department Of Medical Education, Hershey, PA, USA 2Penn State University College Of Medicine, Division Of Vascular Surgery, Hershey, PA, USA
Introduction:
Gabapentinoids are commonly prescribed for chronic neuropathic pain management in patients with peripheral artery disease (PAD). In this study, we investigate the impact of the history of prescribed gabapentinoids on postoperative risk of opioid-related disorders (abuse and dependence) in PAD patients undergoing lower extremity bypass (LEB) for life-limiting claudication and critical limb-threatening ischemia (CLTI).
Methods:
This is a retrospective propensity-score matched analysis of patients undergoing peripheral arterial bypass in TriNetX, a multicenter database. Two study groups were constituted based on the preoperative history of gabapentinoid. Group I comprised PAD patients with a history of gabapentin or pregabalin prior to LEB. Group II comprised PAD patients with no history of gabapentin or pregabalin prior to LEB. The patient population was matched using propensity score matching for balancing cohort and controlling for potential confounders including age, sex, history of diabetes mellites, and history of opioid-related disorders. The outcomes were reported at various time endpoints, and effect estimates were reported in hazard ratios (HR), Odd ratios (OR), and 95% confidence intervals (CIs), and significance was set at p-value <0.05.
Results:
The study cohort included 25,558 patients after propensity-score matching. Group I (n=12,779) had 60% males and 40% females with a mean age of 66.1 years (SD ± 9.6). Group II (n=12,779) had 60% males and 40% females with a mean age of 66.0 years (SD ± 9.6). Primary outcomes showed a significantly increased 5-year risk for opioid-related disorders (Hazard ratio = 1.395, CI [1.248, 1.559], p<0.001) in group I compared to group II. Logistic regression analysis controlling for fifteen (15) covariates showed a statistically significant increase in the 5-year opioid dependence and abuse risk in patients with a history of gabapentinoid (OR 1.42, CI [1.266, 1.593], p<0.001). Secondary analysis showed a dose-dependent increase in the risk of 5-year opioid dependence and abuse in patients with a history of gabapentin (100mg [4%], 300mg [5.6%], 400mg [6.8%], 600mg [9%], 800mg [12.3%], p<0.001) and composite 6.7% risk in the gabapentin subgroup compared to 4.9% risk in the control group (p<0.001).
Conclusion:
In patients undergoing lower extremity bypass with a history of gabapentinoid use in the preoperative time period, there is an increased long-term risk of opioid abuse and dependence. These results underscore the importance of identifying such patients to be at high risk for developing long-term opioid dependence which is associated with opioid-related higher morbidity and mortality. There is a critical need for effective postoperative pain management planning and the involvement of the patient and other healthcare professionals in coordinating care to mitigate potential risks of opioid abuse and dependence.