Prevalence of Chronic Opioid Use in Patients with Peripheral Arterial Disease Undergoing Revascularization.
OBJECTIVES Opiate use, dependence, and the associated morbidity and mortality are major current public health problems in the United States. Little is known about patterns of opioid use in patients with peripheral arterial disease (PAD) The purpose of this study was to identify the prevalence of chronic preoperative and postoperative prescription opioid use in patients with PAD. A secondary aim was to determine the demographic, comorbid conditions, and operative characteristics associated with chronic opioid use. METHODS Using a single institution database of patients with PAD undergoing open or endovascular lower extremity intervention from 2013 2014, data regarding opiate use and associated conditions were abstracted for analysis. Patients were excluded if they did not live in North Carolina or surgery was not for PAD. Preoperative (PreCOU) and postoperative chronic opioid use (PostCOU) were defined as consistent opioid prescription filling in the three months before and after the index procedure, respectively. Opioid prescription filling was assessed using the North Carolina Controlled Substance Reporting System. Demographics, comorbid conditions, other adjunct pain medication data, and operative characteristics were abstracted from our institutional electronic medical record. Associations with PreCOU were evaluated using t test, Wilcoxon test, or two sample median test (continuous) or chi square or Fisher's exact test (categorical) RESULTS 202 patients undergoing open [108 (53.5% or endovascular [94 (46.5% revascularization for claudication or critical limb ischemia were identified for analysis. Mean age was 64.6 years and 36% were female. Claudication was the indication for revascularization in 26.7% of patients and CLI was the indication in 73.3% of patients. Median preoperative ABI was 0.50. Sixty eight patients (34% met the definition for PreCOU. PreCOU was associated with female gender, history of chronic musculoskeletal pain, benzodiazepine use, and self reported illicit drug use. Less than 50% of patients reported use of non opiate adjunct pain medications. No association was observed between PreCOU and pre or postoperative ABI, or number of prior lower extremity interventions. Following revascularization, median ABI was 0.88. PreCOU was not associated with significant differences in postoperative complications, length of stay, or mortality. Overall, 71 patients (35% met the definition for PostCOU, 14 of whom had no history of preoperative chronic opiate use. Ten patients with PreCOU did not demonstrate PostCOU. CONCLUSIONS Chronic opiate use was common in patients with PAD with a prevalence of approximately 35% both prior to and following revascularization. Revascularization was associated with a termination of chronic opiate use in less than 15% of patients with PreCOU. Additionally, 10% of patients who did not use opiates chronically before their revascularization did so afterwards. Patients with PAD requiring intervention represent a high risk group with regards to chronic opiate use. Increased diligence in identifying opioid use among PAD patients and optimizing the use of non narcotic adjunct pain medications may result in a lower prevalence of chronic opiate use and its attendant adverse effects.
Journal of vascular surgery