Opioid Use Trajectories after Thoracic Surgery among Veterans in the United States

Abstract

Background

Opioid use has increased to epidemic levels over the past decade within the United States, particularly among vulnerable populations. This retrospective study aimed to evaluate rates of prolonged opioid use in the Veteran population after thoracic surgery and identify specific risk clusters.

Methods

Veterans Administration data on patients who underwent thoracic surgery between January 1, 2006 and September 30, 2015 included preoperative opioid‐use information for stratification of patients to preoperative chronic opioid use (PCOU; n_PCOU = 16,612) vs. patients without preoperative chronic opioid use (WPCOU; n_WPCOU = 2,328). A Poisson regression model and prior literature were used to identify variables for use in a Latent Class Analysis (LCA) model for each stratum. Three‐cluster models were selected, and identified as “low”, “intermediate” and “high” risk groups.

Results

Cluster interpretations included: 1. Low‐risk: no psychiatric diagnoses, preoperative medication use, or preoperative chronic pain, 2. Intermediate risk: no psychiatric diagnoses, but had preoperative medication use and some preoperative chronic pain, and 3. High‐risk: psychiatric diagnoses, preoperative medication use and preoperative chronic pain. For the PCOU stratum, rates of prolonged opioid use 1 year after surgery were: 46.3%, 61.9% and 66.0%. For the WPCOU stratum, the observed rates were 4.7%, 8.3% and 9.2%.

Conclusions

Prolonged opioid use trajectories obviously differ by PCOU status, as well as preoperative psychosocial diagnoses, medication use and chronic pain. This is a first step in population‐level research to curb the rate of prolonged opioid use in Veterans following thoracic surgery.

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