Association Between Intra- and Postoperative Opioids in Opioid-Naïve Patients in Thoracic Surgery

BACKGROUND:As the opioid epidemic continues, a better understanding of the use of opioids in surgery is needed.We examined whether intra-operative opioid administration was associated with greater post-operative opioid use prior to discharge in opioid naïve patients undergoing thoracic surgery.Further, we sought to determine predictors of higher intra-and post-operative opioid use including demographic and patient factors and hospital. METHODS:Data on patients who underwent elective thoracic surgery between January 1, 2018, and December 31, 2019, were extracted from a data repository at a large health system in the Southeast.All patients and data on total intra-operative and post-operative (prior to discharge) opioid administration were included.A total of 126 patient encounters were analyzed. RESULTS:Increased intra-operative morphine milligram equivalent (MME) was associated with increased post-operative administration, where each unit increase in intra-operative MME was associated with 0.57 increased units in post-operative use (B= 0.57; 95% CI 0.29-0.87,p < 0.0003), controlling for patient race, gender, age, weight, Elixhauser comorbidity score and hospital.Younger age (p < 0.002), comorbidity (p <0.054) and weight (p 0< 0.026) were associated with higher intra-and post-operative opioid, but race (p <0.320) and gender (p.<0.980) were not associated with opioid administration. CONCLUSIONS:Intra-operative opioid use had a significant impact on post-operative opioid use in patients undergoing elective thoracic surgery, even when controlling for age, weight, comorbidities, race and gender.Substantial variation in both intra-and post-operative opioid administration was noted.