Day-of-Surgery Gabapentinoids and Prolonged Opioid Use: A Retrospective Cohort Study of Medicare Patients using Electronic Health Records

Details

• Alternative Title:
  Anesth Analg
• Personal Author:
  Young, Jessica C. ; Dasgupta, Nabarun ; Chidgey, Brooke A. ; Stürmer, Til ; Pate, Virginia ; Hudgens, Michael ; Funk, Michele Jonsson
• Description:
  Background:
  
  While preoperative gabapentinoids are commonly used in surgical multimodal analgesia protocols, little is known regarding the effects this therapy has on prolonged postsurgical opioid use. In this observational study, we used data from a large integrated healthcare system to estimate the association between preoperative day-of-surgery gabapentinoids and the risk of prolonged postsurgical opioid use.
  
  Methods:
  
  We identified adults ≥65 years undergoing major therapeutic surgical procedures from a large integrated healthcare system from 2016–2019. Exposure to preoperative gabapentinoids on the day of surgery was measured using inpatient medication administration records and the outcome of prolonged opioid use was measured using outpatient medication orders. We used stabilized inverse probability of treatment weighted log-binomial regression to estimate risk ratios and 95% confidence intervals (CI) of prolonged opioid use comparing patients who received preoperative gabapentinoids to those who did not, adjusting for relevant clinical factors. The main analysis was conducted in the overall surgical population and a secondary analysis was conducted among procedures where at least 30% of all patients received a preoperative gabapentinoid.
  
  Results:
  
  Overall, 13,958 surgical patients met inclusion criteria, of whom 21.0% received preoperative gabapentinoids. The observed 90-day risk of prolonged opioid use following surgery was 0.91% (95% CI: 0.77%, 1.08%). Preoperative gabapentinoid administration was not associated with a reduced risk of prolonged opioid use in the main analysis including a broad surgical population (adjRR=1.19 [0.67, 2.12]) or in the secondary analysis conducted in patients undergoing colorectal resection, hip arthroplasty, knee arthroplasty, or hysterectomy (adjRR=1.01 [0.30,3.33]).
  
  Conclusions:
  
  In a large integrated health system, we did not find evidence that preoperative gabapentinoids was associated with reduced risk of prolonged opioid use in patients undergoing a broad range of surgeries.
  
  
• Subjects:
  Aged Age Factors Ambulatory Surgical Procedures Analgesics, Non-Narcotic Analgesics, Opioid Drug Administration Schedule Electronic Health Records Female Gabapentin Humans Male Medicare Pain, Postoperative Postoperative Care Preoperative Care Retrospective Studies Time Factors Treatment Outcome United States

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• Keywords:
  Alzheimer's Disease Alzheimer's Disease Sequencing Project Antiviral Agents Herpes Simplex Human Papillomavirus Torque Teno Viruses Whole Exome Sequencing Whole Genome Sequencing
• Source:
  Anesth Analg. 133(5):1119-1128
• Pubmed ID:
  34260433
• Pubmed Central ID:
  PMC8542643
• Document Type:
  Journal Article
• Funding:
  R01 HL118255/HL/NHLBI NIH HHSUnited States/ ; U01 DP006369/DP/NCCDPHP CDC HHSUnited States/ ; UL1 TR002489/TR/NCATS NIH HHSUnited States/ ; R01 MD011680/MD/NIMHD NIH HHSUnited States/ ; R36 DA045885/DA/NIDA NIH HHSUnited States/ ; T32 HS000032/HS/AHRQ HHSUnited States/ ; R01 AG056479/AG/NIA NIH HHSUnited States/
• Volume:
  133
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:2012269287f747cb79beebac952289d6e7f2450988e269aec85c35eda5884f1e413ffdd4645ef95bb90129e14dbed00dab29daf26a115a42153368e51fc9e54b
• Download URL:
  https://stacks.cdc.gov/view/cdc/158053/cdc_158053_DS1.pdf
• File Type:
  [PDF - 686.38 KB ]