Persistent Opioid Use After Surgery for Acute Type A Aortic Dissection
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0255
Submission Type:
Abstract Submission
Authors:
Danial Ahmad (1), Derek Serna-Gallegos (2), Sarah Yousef (3), James Brown (1), Carlos Diaz-Castrillon (4), Nidhi Iyanna (5), Yisi Wang (1), Floyd Thoma (1), Julie Phillippi (6), Michel Pompeu Sá (7), Johannes Bonatti (8), David Kaczorowski (9), Pyongsoo Yoon (1), Danny Chu (10), Ibrahim Sultan (2)
Institutions:
(1) UPMC, Pittsburgh, PA, (2) University of Pittsburgh Medical Center, Pittsburgh, PA, (3) University of Pittsburgh, Pittsburgh, PA, (4) University of Pittsburgh, United States, (5) University of Pittsburgh Medical Center, N/A, (6) N/A, Pittsburgh, PA, (7) PROCAPE / University of Pernambuco, Recife, Pernambuco, (8) UPMC Heart and Vascular Institute, Pittsburgh, PA, (9) University of Pittsburgh Medical Center, Venetia, PA, (10) Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Submitting Author:
Danial Ahmad
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UPMC
UPMC
Co-Author(s):
Derek Serna-Gallegos
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Sarah Yousef
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University of Pittsburgh
University of Pittsburgh
James Brown
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UPMC
UPMC
Carlos Diaz-Castrillon
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University of Pittsburgh
University of Pittsburgh
Nidhi Iyanna
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Yisi Wang
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UPMC
UPMC
Floyd Thoma
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UPMC
UPMC
*Julie Phillippi
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N/A
N/A
Michel Pompeu Sá
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PROCAPE / University of Pernambuco
PROCAPE / University of Pernambuco
♦Johannes Bonatti
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UPMC Heart and Vascular Institute
UPMC Heart and Vascular Institute
*David Kaczorowski
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Pyongsoo Yoon
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UPMC
UPMC
*Danny Chu
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Veterans Affairs Pittsburgh Healthcare System
Veterans Affairs Pittsburgh Healthcare System
*Ibrahim Sultan
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University of Pittsburgh Medical Center
University of Pittsburgh Medical Center
Presenting Author:
Danial Ahmad
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UPMC
UPMC
Abstract:
Objective: The opioid epidemic in the US has been potentially exacerbated by prescription opioids. As aortic dissection is associated with severe pain, we intended to assess the impact of post-surgical opioid prescription on development of persistent opioid use (POU) in patients presenting with acute type A aortic dissections (ATAAD).
Methods: This was a retrospective review of clinical records of patients with a diagnosis of ATAAD presenting to our institution from 2010-2020. Patients' discharge opioid prescriptions were all converted to oral morphine equivalents (OME) for analysis. Only opioid-naïve patients were included, who were defined as having no history of opioid prescription in the six months prior to presentation. Patients with active cancers and no OME or refill information were excluded. POU was defined as any refilling of opioid prescription one week to one year after discharge. Patients were stratified on basis of POU into two groups: POU and no POU. Baseline characteristics and outcomes were compared between the groups. Univariable analysis was undertaken to assess factors associated with POU. Further, the non-linear relationship between total OME at discharge and POU was assessed using splines. P<0.05 was considered statistically significant.
Results: A total of 132 patients were included of which 10.6% (14/132) developed POU. Women comprised 34.9% (46/132) of the population which was 81.8% (108/132) white. Patients in the POU group trended towards being younger (51.5 years (44-63) vs. 61 years (49-70), p=0.07) and undergoing procedures in more recent years (2020: 28.6% (4/14) vs.8.5% (10/118) and 2021: 21.4% (3/14) vs. 2.5% (3/118), p=0.06). POU patients had greater prevalence of chronic pain (21.4% (3/14) vs. 4.2% (5/132), p=0.01).
The 30-day (1.52% (2/132)) and overall mortality rates (12.1% (16/132)) at a follow-up of 5.5 years (3.6-7) were comparable between the groups. Non-POU patients had longer lengths of stay during index admissions (7.3 days (5.6-10.5) vs. 5.3 days (4.8-6.8), p=0.05); however, they had lower overall readmission rates (50% (59/118) vs. 78.6% (11/14), p=0.04).
On univariable analysis (Table), only chronic pain (Odds Ratio (OR): 6.164 (95% confidence interval: 1.296-29.317), p=0.022) was significantly associated with odds of developing POU. Neither was total OME at discharge (OR: 0.996 (0.987-1.005), p=0.381), nor were OME categories associated with odds of developing POU. Analysis of non-linear relationship between total OME at discharge and POU showed a downward trend with increasing dosage of OME (Figure).
Conclusions: Postoperative opioid dosage was not associated with the development of POU; however, a history of chronic pain was associated with POU. This implies reasonable pain control regimens following ATAAD treatment. Nevertheless, individually tailored opioid regimens and close follow-up would be recommended for pain control in younger ATAAD patients with a history of chronic pain.
Methods: This was a retrospective review of clinical records of patients with a diagnosis of ATAAD presenting to our institution from 2010-2020. Patients' discharge opioid prescriptions were all converted to oral morphine equivalents (OME) for analysis. Only opioid-naïve patients were included, who were defined as having no history of opioid prescription in the six months prior to presentation. Patients with active cancers and no OME or refill information were excluded. POU was defined as any refilling of opioid prescription one week to one year after discharge. Patients were stratified on basis of POU into two groups: POU and no POU. Baseline characteristics and outcomes were compared between the groups. Univariable analysis was undertaken to assess factors associated with POU. Further, the non-linear relationship between total OME at discharge and POU was assessed using splines. P<0.05 was considered statistically significant.
Results: A total of 132 patients were included of which 10.6% (14/132) developed POU. Women comprised 34.9% (46/132) of the population which was 81.8% (108/132) white. Patients in the POU group trended towards being younger (51.5 years (44-63) vs. 61 years (49-70), p=0.07) and undergoing procedures in more recent years (2020: 28.6% (4/14) vs.8.5% (10/118) and 2021: 21.4% (3/14) vs. 2.5% (3/118), p=0.06). POU patients had greater prevalence of chronic pain (21.4% (3/14) vs. 4.2% (5/132), p=0.01).
The 30-day (1.52% (2/132)) and overall mortality rates (12.1% (16/132)) at a follow-up of 5.5 years (3.6-7) were comparable between the groups. Non-POU patients had longer lengths of stay during index admissions (7.3 days (5.6-10.5) vs. 5.3 days (4.8-6.8), p=0.05); however, they had lower overall readmission rates (50% (59/118) vs. 78.6% (11/14), p=0.04).
On univariable analysis (Table), only chronic pain (Odds Ratio (OR): 6.164 (95% confidence interval: 1.296-29.317), p=0.022) was significantly associated with odds of developing POU. Neither was total OME at discharge (OR: 0.996 (0.987-1.005), p=0.381), nor were OME categories associated with odds of developing POU. Analysis of non-linear relationship between total OME at discharge and POU showed a downward trend with increasing dosage of OME (Figure).
Conclusions: Postoperative opioid dosage was not associated with the development of POU; however, a history of chronic pain was associated with POU. This implies reasonable pain control regimens following ATAAD treatment. Nevertheless, individually tailored opioid regimens and close follow-up would be recommended for pain control in younger ATAAD patients with a history of chronic pain.
Aortic Symposium:
Dissection
Image or Table
