Postoperative opioid prescribing patients with diabetes: Opportunities for personalized pain management

Opioids are commonly prescribed for postoperative pain, but may lead to prolonged use and addiction. Diabetes impairs nerve function, complicates pain management, and makes opioid prescribing particularly challenging. This retrospective observational study included a cohort of postoperative patients...

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Published in:PloS one 2023-08, Vol.18 (8), p.e0287697
Main Authors: Zammit, Alban, Coquet, Jean, Hah, Jennifer, El Hajouji, Oualid, Asch, Steven M, Carroll, Ian, Curtin, Catherine M, Hernandez-Boussard, Tina
Format: Article
Language:English
Subjects:
Addictions
Analgesics, Opioid - adverse effects
Anesthesia
Biology and Life Sciences
Body mass index
Care and treatment
Diabetes
Diabetes mellitus
Diabetes Mellitus - drug therapy
Diabetes therapy
Diabetics
Diagnosis
Dosage and administration
Drug abuse
Electronic health records
Health risks
Hispanic people
Humans
Hypotheses
Medical diagnosis
Medical research
Medicine and Health Sciences
Medicine, Experimental
Morphine
Narcotics
Observational studies
Opiate Alkaloids
Opioid-Related Disorders
Opioids
Pain
Pain Management
Pain, Postoperative - drug therapy
Patient outcomes
Patients
Practice Patterns, Physicians
Precision medicine
Prescription writing
Prescriptions
Software
Statistical analysis
Surgery
Surgical outcomes
Variables
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cited_by cdi_FETCH-LOGICAL-c693t-4ab6938834b6c5a113eb15c94976aae27c8aa0e0ec45ff6524d66874d9dd8bf13
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container_issue 8
container_start_page e0287697
container_title PloS one
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Coquet, Jean
Hah, Jennifer
El Hajouji, Oualid
Asch, Steven M
Carroll, Ian
Curtin, Catherine M
Hernandez-Boussard, Tina
description Opioids are commonly prescribed for postoperative pain, but may lead to prolonged use and addiction. Diabetes impairs nerve function, complicates pain management, and makes opioid prescribing particularly challenging. This retrospective observational study included a cohort of postoperative patients from a multisite academic health system to assess the relationship between diabetes, pain, and prolonged opioid use (POU), 2008-2019. POU was defined as a new opioid prescription 3-6 months after discharge. The odds that a patient had POU was assessed using multivariate logistic regression controlling for patient factors (e.g., demographic and clinical factors, as well as prior pain and opiate use). A total of 43,654 patients were included, 12.4% with diabetes. Patients with diabetes had higher preoperative pain scores (2.1 vs 1.9, p
doi_str_mv 10.1371/journal.pone.0287697
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Diabetes impairs nerve function, complicates pain management, and makes opioid prescribing particularly challenging. This retrospective observational study included a cohort of postoperative patients from a multisite academic health system to assess the relationship between diabetes, pain, and prolonged opioid use (POU), 2008-2019. POU was defined as a new opioid prescription 3-6 months after discharge. The odds that a patient had POU was assessed using multivariate logistic regression controlling for patient factors (e.g., demographic and clinical factors, as well as prior pain and opiate use). A total of 43,654 patients were included, 12.4% with diabetes. Patients with diabetes had higher preoperative pain scores (2.1 vs 1.9, p&lt;0.001) and lower opioid naïve rates (58.7% vs 68.6%, p&lt;0.001). Following surgery, patients with diabetes had higher rates of POU (17.7% vs 12.7%, p&lt;0.001) despite receiving similar opioid prescriptions at discharge. Patients with Type I diabetes were more likely to have POU compared to other patients (Odds Ratio [OR]: 2.22; 95% Confidence Interval [CI]:1.69-2.90 and OR:1.44, CI: 1.33-1.56, respectively). In conclusion, surgical patients with diabetes are at increased risk for POU even after controlling for likely covariates, yet they receive similar postoperative opiate therapy. The results suggest a more tailored approach to diabetic postoperative pain management is warranted.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0287697</identifier><identifier>PMID: 37616195</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Addictions ; Analgesics, Opioid - adverse effects ; Anesthesia ; Biology and Life Sciences ; Body mass index ; Care and treatment ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - drug therapy ; Diabetes therapy ; Diabetics ; Diagnosis ; Dosage and administration ; Drug abuse ; Electronic health records ; Health risks ; Hispanic people ; Humans ; Hypotheses ; Medical diagnosis ; Medical research ; Medicine and Health Sciences ; Medicine, Experimental ; Morphine ; Narcotics ; Observational studies ; Opiate Alkaloids ; Opioid-Related Disorders ; Opioids ; Pain ; Pain Management ; Pain, Postoperative - drug therapy ; Patient outcomes ; Patients ; Practice Patterns, Physicians ; Precision medicine ; Prescription writing ; Prescriptions ; Software ; Statistical analysis ; Surgery ; Surgical outcomes ; Variables</subject><ispartof>PloS one, 2023-08, Vol.18 (8), p.e0287697</ispartof><rights>Copyright: © 2023 Zammit et al. 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Diabetes impairs nerve function, complicates pain management, and makes opioid prescribing particularly challenging. This retrospective observational study included a cohort of postoperative patients from a multisite academic health system to assess the relationship between diabetes, pain, and prolonged opioid use (POU), 2008-2019. POU was defined as a new opioid prescription 3-6 months after discharge. The odds that a patient had POU was assessed using multivariate logistic regression controlling for patient factors (e.g., demographic and clinical factors, as well as prior pain and opiate use). A total of 43,654 patients were included, 12.4% with diabetes. Patients with diabetes had higher preoperative pain scores (2.1 vs 1.9, p&lt;0.001) and lower opioid naïve rates (58.7% vs 68.6%, p&lt;0.001). Following surgery, patients with diabetes had higher rates of POU (17.7% vs 12.7%, p&lt;0.001) despite receiving similar opioid prescriptions at discharge. Patients with Type I diabetes were more likely to have POU compared to other patients (Odds Ratio [OR]: 2.22; 95% Confidence Interval [CI]:1.69-2.90 and OR:1.44, CI: 1.33-1.56, respectively). In conclusion, surgical patients with diabetes are at increased risk for POU even after controlling for likely covariates, yet they receive similar postoperative opiate therapy. The results suggest a more tailored approach to diabetic postoperative pain management is warranted.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>37616195</pmid><doi>10.1371/journal.pone.0287697</doi><tpages>e0287697</tpages><orcidid>https://orcid.org/0000-0002-2524-1113</orcidid><orcidid>https://orcid.org/0000-0002-9739-3968</orcidid><orcidid>https://orcid.org/0000-0001-6553-3455</orcidid><oa>free_for_read</oa></addata></record>
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subjects Addictions
Analgesics, Opioid - adverse effects
Anesthesia
Biology and Life Sciences
Body mass index
Care and treatment
Diabetes
Diabetes mellitus
Diabetes Mellitus - drug therapy
Diabetes therapy
Diabetics
Diagnosis
Dosage and administration
Drug abuse
Electronic health records
Health risks
Hispanic people
Humans
Hypotheses
Medical diagnosis
Medical research
Medicine and Health Sciences
Medicine, Experimental
Morphine
Narcotics
Observational studies
Opiate Alkaloids
Opioid-Related Disorders
Opioids
Pain
Pain Management
Pain, Postoperative - drug therapy
Patient outcomes
Patients
Practice Patterns, Physicians
Precision medicine
Prescription writing
Prescriptions
Software
Statistical analysis
Surgery
Surgical outcomes
Variables
title Postoperative opioid prescribing patients with diabetes: Opportunities for personalized pain management
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