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A prospective observational study of persistent opioid use after complex foot and ankle surgery

Étude observationnelle prospective de la consommation persistante d’opioïdes après une chirurgie complexe du pied et de la cheville

Abstract

Purpose

The incidence of persistent postsurgical opioid use (PPOU) after complex foot and ankle surgery is unknown. We aimed to determine the incidence and characteristics of PPOU in opioid-naïve, occasional, and regular opioid users at baseline and at six weeks, three months, and six months postoperatively.

Methods

We conducted a prospective observational study in patients undergoing complex foot and ankle surgery over an 18-month period. Daily opioid consumption was recorded at the indicated intervals. Logistic regression models were fit to predict the risk of opioid use at these intervals. The Brief Pain Inventory (BPI) was used to record pain intensity and interference. Correlations were tested between opioid use and BPI interference parameters.

Results

Eighty-two out of 139 consecutively approached patients were included in the final analysis. Six percent (98.3% confidence interval [CI], 2 to 20) of patients who were not using opioids preoperatively at baseline were using opioids daily at three and six months after surgery. Fifty percent (98.3% CI, 26 to 73) of patients who were regular opioid users preoperatively continued to use opioids daily six months after surgery. All associations between BPI interference parameters and opioid use were estimated to be positive.

Conclusion

The probability of using opioid analgesia six months after complex foot and ankle surgery was significantly higher in patients who used opioids preoperatively. Regular preoperative opioid use was associated with a greater risk of PPOU compared with occasional or “as required” opioid use prior to surgery.

Résumé

Objectif

L’incidence de consommation persistante d’opioïdes après une chirurgie (CPOC) après une chirurgie complexe du pied et de la cheville est inconnue. Notre objectif était de déterminer l’incidence et les caractéristiques de la CPOC chez les utilisateurs d’opioïdes naïfs, occasionnels et réguliers avant leur opération, puis à six semaines, trois mois et six mois après l’opération.

Méthode

Nous avons réalisé une étude observationnelle prospective sur une période de 18 mois auprès de patients bénéficiant d’une chirurgie complexe du pied et de la cheville. La consommation quotidienne d’opioïdes a été enregistrée aux intervalles indiqués. Des modèles de régression logistique ont été utilisés pour prédire le risque de consommation d’opioïdes à ces intervalles. Le Questionnaire concis de la douleur (QCD - version française du Brief Pain Inventory, BPI) a été utilisé pour enregistrer l’intensité de la douleur et son interférence. Des corrélations ont été testées entre la consommation d’opioïdes et les paramètres d’interférence du QCD.

Résultats

Quatre-vingt-deux des 139 patients approchés consécutivement ont été inclus dans notre analyse finale. Six pour cent (intervalle de confiance [IC] à 98,3 %, 2 à 20) des patients qui ne consommaient pas d’opioïdes avant l’opération utilisaient des opioïdes quotidiennement trois et six mois après la chirurgie. Cinquante pour cent (IC 98,3 %, 26 à 73) des patients qui étaient des consommateurs réguliers d’opioïdes avant l’opération ont continué à utiliser des opioïdes quotidiennement six mois après la chirurgie. Toutes les associations entre les paramètres d’interférence du QCD et la consommation d’opioïdes ont été estimées positives.

Conclusion

La probabilité d’avoir recours à une analgésie opioïde six mois après une chirurgie complexe du pied et de la cheville était significativement plus élevée chez les patients qui consommaient déjà des opioïdes avant leur opération. La consommation régulière d’opioïdes avant l’opération a été associée à un risque plus élevé de CPOC par rapport à l’utilisation occasionnelle ou « au besoin » d’opioïdes avant la chirurgie.

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Notes

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Author contributions

Michelle Verrier, Shuang Niu, and Chris Douglas contributed to study design and data collection. Kimberly Kroetch contributed to statistical analysis. Karen Buro contributed to statistical analysis and writing the manuscript. James Green and Mary E. Pedersen, and Derek Dillane contributed to study design and writing the manuscript.

Disclosures

None.

Funding statement

None.

Editorial responsibility

This submission was handled by Dr. Stephan K.W. Schwarz, Editor-in-Chief, Canadian Journal of Anesthesia/ Journal canadien d’anesthésie.

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Correspondence to Derek Dillane MB BCh, BAO, FCARCSI.

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Verrier, M., Niu, S., Kroetch, K. et al. A prospective observational study of persistent opioid use after complex foot and ankle surgery. Can J Anesth/J Can Anesth (2021). https://doi.org/10.1007/s12630-021-02104-0

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Keywords

  • Persistent postsurgical opioid use
  • Complex foot and ankle surgery
  • Brief pain inventory