Preoperative prescription opioid use as an independent predictor of 90-day mortality and adverse events in craniotomy and craniectomy patients

Author:

Shah Varun S.12,Dornbos David34,Hoang Nguyen (Alex)3,Cua Santino1,Rodgers Brandon1,Pezzutti Dante1,Duenas Helen1,Eaton Ryan3,Kreatsoulas Daniel3,Elder J. Bradley3,Prevedello Daniel M.3,Lonser Russell R.3,Nimjee Shahid M.3

Affiliation:

1. College of Medicine, The Ohio State University, Columbus, Ohio;

2. Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio;

3. Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio; and

4. Department of Neurological Surgery, University of Tennessee Health Science Center and Semmes Murphey Clinic, Memphis, Tennessee

Abstract

OBJECTIVE A growing body of literature suggests that preoperative opioid exposure is an independent predictor of poor outcomes in surgical patients. No outcomes data exist on preoperative opioid use and craniotomies/craniectomies. The objective of this study was to determine the impact of preoperative opioid use on 90-day adverse events after craniotomy or craniectomy. METHODS A single-center retrospective cohort study of 2445 patients undergoing a craniotomy/craniectomy between January 1, 2013, and October 1, 2018, was conducted. Baseline demographics, pre- and postoperative opioid use (morphine milligram equivalents [MMEs]), and surgical metrics were recorded. Patients were categorized based on whether they took prescription opioids preoperatively, defined as within 1 month of surgery, or were opioid naive. The outcomes were mortality and adverse events 90 days after craniotomy/craniectomy. RESULTS Overall, 26.6% of patients composed the preoperative opioid group. The median daily MME intake among this group was 34.6 (IQR 14.1–90) MMEs. Lower employment rates (p < 0.001), uninsured status (p = 0.016), and intravenous drug use (p = 0.006) were associated with preoperative opioid use. Preoperative opioid use was associated with increased venous thromboembolism (p = 0.001), acute kidney injury (p = 0.002), acute respiratory failure (p < 0.001), myocardial infarction (p = 0.002), delirium (p < 0.001), and infection (p < 0.001). Preoperative opioid use was an independent predictor of overall 90-day adverse events (OR 1.643, 95% CI 1.289–2.095; p < 0.001) and 90-day mortality (OR 1.690, 95% CI 1.254–2.277; p < 0.001). CONCLUSIONS Preoperative opioid use was independently associated with 90-day postoperative adverse events and mortality. Opioid use increases vulnerability in craniotomy/craniectomy patients and necessitates close monitoring to improve outcomes.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Reference32 articles.

1. Increases in drug and opioid overdose deaths—United States, 2000-2014;Rudd RA,2016

2. Postoperative opioid prescribing and consumption patterns after tonsillectomy;Choo S,2019

3. Long-term analgesic use after low-risk surgery: a retrospective cohort study;Alam A,2012

4. Comparison of opioid utilization patterns after major head and neck procedures between Hong Kong and the United States;Li RJ,2018

5. Opioid abuse or dependence increases 30-day readmission rates after major operating room procedures: a National Readmissions Database study;Gupta A,2018

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3