Opioid Dependence After Lung Cancer Resection: Institutional Analysis of State Prescription Drug Database
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ORIGINAL SCIENTIFIC REPORT
Opioid Dependence After Lung Cancer Resection: Institutional Analysis of State Prescription Drug Database Nick C. Levinsky1 • Matthew M. Byrne2 • Dennis J. Hanseman1 • Alexander R. Cortez1 Julian Guitron3 • Sandra L. Starnes3 • Robert M. Van Haren3
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Accepted: 7 November 2020 Ó Socie´te´ Internationale de Chirurgie 2020
Abstract Background The national opioid epidemic is a public health crisis. Thoracic surgery has also been associated with high incidence of new persistent opioid use. Our purpose was to describe the incidence and predictors of opioid use after lung cancer resection. Methods Retrospective review of lung cancer resections from 2015 to 2018 was performed using the Ohio Automated Rx Reporting System. Opioid dosing was recorded as milligram morphine equivalents (MME). Patients were stratified by preoperative opioid use. Chronic preoperative opioid users (opioid dependent) filled [ 120 days supply of opioid pain medication in the 12 months prior to surgery; intermittent opioid users filled \ 120 days. Chronic postoperative opioid users continued monthly use after 180 days postoperatively. Results 137 patients underwent resection. 16.1% (n = 22) were opioid dependent preoperatively, 29.2% (n = 40) were intermittent opioid users, and 54.7% (n = 75) were opioid naı¨ve. Opioid dependent patients had higher daily inpatient opioid use compared to intermittent users and opioid naı¨ve (43[30.0–118.1] MME vs 17.9[3.5–48.8] MME vs 8.8[2.1–25.0] MME, p \ 0.001). Twenty-six percent (n = 35) of all patients were opioid users beyond 180 days postoperatively. Variables associated with opioid use [ 180 days were: chronic preoperative opioid use (OR 23.8, p \ 0.01), daily inpatient opioid requirement (1.02, p \ 0.01), and neoadjuvant chemotherapy (28.2, p \ 0.01). Conclusions A quarter of patients are opioid dependent after lung cancer resection. This is due to both preexisting and new persistent opioid use. Improved strategies are needed to prevent chronic pain and opioid dependence after lung cancer resection.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00268-020-05865-9) contains supplementary material, which is available to authorized users. & Robert M. Van Haren [email protected]
Abbreviations OARRS Ohio Automated Rx Reporting System PDMP Prescription drug monitoring program MME Milligram morphine equivalents NPOU New persistent opioid use
1
Department of Surgery, University of Cincinnati, Cincinnati, OH, USA
2
College of Medicine, University of Cincinnati, Cincinnati, OH, USA
Introduction
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Division of Thoracic Surgery, Department of Surgery, University of Cincinnati, 231 Albert Sabin Way ML-0558, Medical Sciences Building, Room 2472, Cincinnati, OH, USA
Opioid use in the USA represents a significant public health crisis. The US Centers for Disease Control and Prevention reported greater than 47,000 deaths in 2017 due
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to opioid overdoses [1]. Surgery may result in chronic opioid dependence, and thor
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