The Incidence of Opioid Use in Patients Undergoing Orthopaedic Oncology Surgery
Sheena J Amin1 MD, Alec S Kellish2 MD, David Le3 DO, John P Gaughan4 MS PhD MBA, Tae Won B Kim4 MD, Christina J Gutowski4 MD MPH
Objective: Primary or metastatic cancer can cause debilitating pain. Despite societal concerns regarding opioid use and abuse, opioid utilization patterns in orthopaedic oncology patients is not well-described. The purpose of this study is to determine patterns of opioid use in orthopaedic oncology patients and to identify factors associated with chronic use postoperatively.
Methods: A retrospective review of 119 orthopaedic oncology patients who underwent surgical treatment for a bone or soft tissue tumor at our institution between November 2017 and August 2018 was conducted. Opioid consumption was measured using the New Jersey Prescription Monitoring Program, a database that monitors when a controlled substance prescription is dispensed. Utilization rates at various perioperativetimepoints were measured, and factors associated with chronic use were identified using single variable logistic regression.
Results: At the initial encounter with the orthopaedic oncologist, 18.1% of patients were using opioids, which increased to 51.3% at 2 weeks postoperatively. The prevalence declined to 25.2% by 6 weeks postoperatively, and 15.9% by 1 year postoperatively. The highest prevalence of chronic opioid use, defined as opioid use on most days for greater than 3 months, was 17.7% at 3 months postoperatively. Factors associated with chronic opioid use postoperatively included continued opioid use at 6 weeks postoperatively, chronic opioid use preoperatively, Charlson Comorbidity Index, diabetes, metastatic cancer, soft tissue tumors, and VAS scores.
Conclusions: By understanding opioid consumption habits, and the factors associated with chronic use postoperatively, orthopaedic oncologists can better counsel their patients on the potential for addiction and individual propensity for developing chronic use. Persistent opioid consumption at 6 weeks postoperatively was associated with the development of chronic use, suggesting that the 6 week mark should serve as a warning threshold, and providers should therefore attempt to wean patients from opioids by 6 weeks postoperatively.