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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...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2021
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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. |
format | Online Article Text |
id | pubmed-8760026 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
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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