History of Preoperative Use of Gabapentin Before Lower Extremity Bypass Predisposes Patients to a High Risk of Opioid Use and Dependence in a Dose-Dependent Manner

Patients suffering from peripheral artery disease are commonly prescribed gabapentinoids (GBPs; gabapentin and pregabalin) for pain management. In this study, we investigate the impact of preoperative use of GBPs on postoperative risk of opioid-related disorders in patients with peripheral artery disease undergoing lower extremity bypass operation. This is a retrospective propensity-score-matched analysis of patients undergoing peripheral artery bypass in TriNetX, a multicenter population-level database. Two study groups were constituted based on the preoperative history of prescribed GBPs. Patients with a history of opioid-related disorders before lower extremity bypass were excluded from the study. The patient population was matched using propensity score matching to balance the groups on potential confounders. Primary outcomes were opioid-related disorders and mortality. The outcomes were reported at two time end points (1 and 5 years), and effect estimates were reported in adjusted odd ratios (OR) and 95% confidence intervals (CIs), Bonferroni-adjusted P values were calculated, and significance was set at a P value of 1600 mg/d) (6.1%). In patients undergoing lower extremity bypass with a history of gabapentin use, there is an associated increased long-term risk of opioid-related disorders in a dose-dependent manner. Overall, this study highlights the importance of understanding, evaluating, and further investigating the risk-to-benefit ratio of prescribing GBPs for pain control vs their long-term risk of opioid-related disorders among other adverse outcomes.