The researchers at Johns Hopkins University found that preoperative diagnoses of depression or anxiety were associated with increased rates of multiday hospitalization, 90-day readmission, revision within 2 years, and postoperative opioid use. Additionally, depression resulted in a 2-year health care payment cost increase of $5,915. Anxiety resulted in an increase of $4,471 for the same measure. Interestingly, similar metrics on a shorter-term basis were not significantly increased.
Finally, a group at Stanford University developed a screening tool to predict postoperative opioid use. The publication, “A predictive-modeling based screening tool for prolonged opioid use after surgical management of low back and lower extremity pain,” describes the development of a model using data from MarketScan databases, a source covering about 50% of the American employer-insured population, and 40% of American retirees.
The study authors used 80% of the data to develop 7 models, and tested the models on the remaining 20% of the data. They found that the regression-based models offered the highest area under the curve (AUC) (0.835-0.847), a measure of the model’s accuracy, and relatively high sensitivity (74.9%-76.5%). The model identified high preoperative opioid use, number of days with an active opioid prescription and number of dosage increases between postoperative days 15-30 as the three strongest predictors of increased long-term opioid use.
The models also identified the number of dosage decreases in the 30-day postoperative period as the strongest negative indicator of long-term opioid use. The model is available online.
One strategy to reduce opioid use is through the use of non-opioid pain medications. Options range from over-the-counter drugs such as acetaminophen and ibuprofen to other prescription medications like gabapentinoids. Other drugs and drug combinations are currently in development, such as ZYNRELEF, which is a combination drug from Heron Therapeutics, Inc.
ZYNRELEF contains bupivacaine, a local anesthetic, with a low dose of the NSAID, meloxicam. The company recently announced positive news for the drug from the European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP). Its two phase 3 studies found that ZYNRELEF significantly reduced pain and opioid use through 72 hours compared to bupivacaine alone.
