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Effect of Preoperative Chronic Opioid Use on Mortality and Morbidity in Vascular Surgical Patients

Introduction Opioid derivates are an essential part of everyday clinical pain management practice. They have excellent analgesic, sedative, and sympatholytic effects and are widely used in various conditions. Beyond advantageous aspects, there are numerous problems with the chronic use of these agen...

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Autores principales: Szabo, Andras, Szabo, Dominika, Toth, Krisztina, Szecsi, Balazs, Sandor, Agnes, Szentgroti, Rita, Parkanyi, Boglar, Merkely, Bela, Gal, Janos, Szekely, Andrea
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8760026/
https://www.ncbi.nlm.nih.gov/pubmed/35047302
http://dx.doi.org/10.7759/cureus.20484
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author Szabo, Andras
Szabo, Dominika
Toth, Krisztina
Szecsi, Balazs
Sandor, Agnes
Szentgroti, Rita
Parkanyi, Boglar
Merkely, Bela
Gal, Janos
Szekely, Andrea
author_facet Szabo, Andras
Szabo, Dominika
Toth, Krisztina
Szecsi, Balazs
Sandor, Agnes
Szentgroti, Rita
Parkanyi, Boglar
Merkely, Bela
Gal, Janos
Szekely, Andrea
author_sort Szabo, Andras
collection PubMed
description Introduction Opioid derivates are an essential part of everyday clinical pain management practice. They have excellent analgesic, sedative, and sympatholytic effects and are widely used in various conditions. Beyond advantageous aspects, there are numerous problems with the chronic use of these agents. Dependency and life-threatening complications are the biggest problems with both illegal and prescribed opioid derivates. In our current study, effects of chronic opioid use were observed on mortality and life quality in the case of vascular surgery. Methods This prospective, observational study was conducted between 2014 and 2017. After obtaining informed consent, all participants were asked to fill a questionnaire containing different psychological tests. Perioperative data, chronic medical therapy, and anthropometric data were also collected. Opioid user and non-user patients’ psychological results were compared with non-parametrical tests. The effect of chronic opioid administration was investigated with logistic regression method with bootstrapping. Results Finally, the data of 164 patients were analyzed. 64.0% of participants were male, the mean age was 67.05 years, and the standard deviation was 9.48 years. The median follow-up time was 1312 days [interquartile range (IQR): 930-1582 days]. During the follow-up time, 42 patients died (25.6%). In the examined patient cohort, the frequency of opioid derivate use was 3.7% (only six patients). In the non-survived group, opioid use was significantly higher (1.6% vs. 9.5%, p=0.019). Significant differences were found in the aspect of cognitive performance measured by Mini-Mental State Examination (MMSE), opioid users have had lower points [25.5 (IQR: 24.5-26.0) vs. 28.0 (IQR: 27.0-29.0) p=0.008]. Opioid users have showed higher score on Beck Depression Inventory (BDI) [15.5 (IQR: 10.0-18.0) vs. 6.0 (IQR: 3.0-11.0), p=0.030). In a multivariate Cox regression model built up from registered preoperative medical treatment, opioids were found as a risk factor for all-cause mortality [adjusted hazard ratio (AHR): 4.31, 95% CI: 1.77-10.55, p=0.001]. Conclusion Our current findings suggest that chronic, preoperative use of opioids could associate with increased mortality. Furthermore, both decrease in cognitive performance and increased depression symptoms were found in the opioid user cohorts which emphasize the importance of further risk stratification of these patients.
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spelling pubmed-87600262022-01-18 Effect of Preoperative Chronic Opioid Use on Mortality and Morbidity in Vascular Surgical Patients Szabo, Andras Szabo, Dominika Toth, Krisztina Szecsi, Balazs Sandor, Agnes Szentgroti, Rita Parkanyi, Boglar Merkely, Bela Gal, Janos Szekely, Andrea Cureus Anesthesiology Introduction Opioid derivates are an essential part of everyday clinical pain management practice. They have excellent analgesic, sedative, and sympatholytic effects and are widely used in various conditions. Beyond advantageous aspects, there are numerous problems with the chronic use of these agents. Dependency and life-threatening complications are the biggest problems with both illegal and prescribed opioid derivates. In our current study, effects of chronic opioid use were observed on mortality and life quality in the case of vascular surgery. Methods This prospective, observational study was conducted between 2014 and 2017. After obtaining informed consent, all participants were asked to fill a questionnaire containing different psychological tests. Perioperative data, chronic medical therapy, and anthropometric data were also collected. Opioid user and non-user patients’ psychological results were compared with non-parametrical tests. The effect of chronic opioid administration was investigated with logistic regression method with bootstrapping. Results Finally, the data of 164 patients were analyzed. 64.0% of participants were male, the mean age was 67.05 years, and the standard deviation was 9.48 years. The median follow-up time was 1312 days [interquartile range (IQR): 930-1582 days]. During the follow-up time, 42 patients died (25.6%). In the examined patient cohort, the frequency of opioid derivate use was 3.7% (only six patients). In the non-survived group, opioid use was significantly higher (1.6% vs. 9.5%, p=0.019). Significant differences were found in the aspect of cognitive performance measured by Mini-Mental State Examination (MMSE), opioid users have had lower points [25.5 (IQR: 24.5-26.0) vs. 28.0 (IQR: 27.0-29.0) p=0.008]. Opioid users have showed higher score on Beck Depression Inventory (BDI) [15.5 (IQR: 10.0-18.0) vs. 6.0 (IQR: 3.0-11.0), p=0.030). In a multivariate Cox regression model built up from registered preoperative medical treatment, opioids were found as a risk factor for all-cause mortality [adjusted hazard ratio (AHR): 4.31, 95% CI: 1.77-10.55, p=0.001]. Conclusion Our current findings suggest that chronic, preoperative use of opioids could associate with increased mortality. Furthermore, both decrease in cognitive performance and increased depression symptoms were found in the opioid user cohorts which emphasize the importance of further risk stratification of these patients. Cureus 2021-12-17 /pmc/articles/PMC8760026/ /pubmed/35047302 http://dx.doi.org/10.7759/cureus.20484 Text en Copyright © 2021, Szabo et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Anesthesiology
Szabo, Andras
Szabo, Dominika
Toth, Krisztina
Szecsi, Balazs
Sandor, Agnes
Szentgroti, Rita
Parkanyi, Boglar
Merkely, Bela
Gal, Janos
Szekely, Andrea
Effect of Preoperative Chronic Opioid Use on Mortality and Morbidity in Vascular Surgical Patients
title Effect of Preoperative Chronic Opioid Use on Mortality and Morbidity in Vascular Surgical Patients
title_full Effect of Preoperative Chronic Opioid Use on Mortality and Morbidity in Vascular Surgical Patients
title_fullStr Effect of Preoperative Chronic Opioid Use on Mortality and Morbidity in Vascular Surgical Patients
title_full_unstemmed Effect of Preoperative Chronic Opioid Use on Mortality and Morbidity in Vascular Surgical Patients
title_short Effect of Preoperative Chronic Opioid Use on Mortality and Morbidity in Vascular Surgical Patients
title_sort effect of preoperative chronic opioid use on mortality and morbidity in vascular surgical patients
topic Anesthesiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8760026/
https://www.ncbi.nlm.nih.gov/pubmed/35047302
http://dx.doi.org/10.7759/cureus.20484
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