Perioperative Opioid Exposure in Adolescents and Long-Term Psychiatric/Utilization Outcomes: A Propensity-Matched Real World Cohort Study
A. S. Verma, V. Sharma, A. Pathak, R. GuptaIntroduction
Use of opioids peri-operatively, for both analgesia and anesthesia, is being highlighted negatively due to the opioid crisis in the United States. There is evidence that being exposed to opioids peri-operatively, alters neurobiology by disrupting the dopamine and serotonin pathways, through action on the hypothalamic-pituitary-axis, especially in the pliable adolescent brain. This can result in development of long term psychiatric comorbidity, opioid use disorder and consequent increased emergency healthcare visits.
Objectives
To test whether perioperative opioid exposure after common adolescent procedures is associated with long-term psychiatric diagnoses, emergency department (ED) utilization, overdose, and indicators of opioid use treatment, when compared with non-opioid analgesia.
Methods
We conducted a retrospective cohort study on the TriNetX US Collaborative Network (71 health systems). Adolescents aged 12–19 undergoing common procedures (appendectomy, tonsil/adenoid, select orthopedic and dental procedures) were identified. The opioid cohort had a perioperative opioid use (−3 to +7 days around surgery); the comparison cohort had no perioperative opioid use. Key exclusions at baseline: prior opioid-related disorders (F11), any substance-use disorders (F10–F19), and chronic pain (G89.2). Outcomes (depression, anxiety, PTSD, sleep disorders, suicidal ideation/attempt, ED utilization, opioid poisoning/overdose, long-term opioid therapy [Z79.891], and MOUD/overdose-related medications [buprenorphine, methadone, naltrexone, naloxone]) were assessed from day 1 to 3,650 (~10 years) post-index. Propensity score matching 1:1 was performed on age, sex, and ethnicity; measures of association and Kaplan–Meier analyses were run on matched cohorts (Table 1).
Results
After matching (n=
77,810
per cohort), perioperative opioids were associated with higher risk of depression (RR 1.195, 95%CI 1.126–1.268), anxiety (RR 1.215, 1.168–1.264), sleep disorders (RR 1.296, 1.238–1.356), suicidal ideation/attempt (RR 1.121, 1.027–1.223), ED utilization (RR 1.187, 1.158–1.215), and opioid poisoning/overdose (RR 1.522, 1.049–2.208). Long-term opioid therapy (Z79.891) was not increased (RR 0.952, 0.820–1.104). Initiation of MOUD/overdose-related medications was markedly higher (RR 2.912, 2.572–3.298). Notably, PTSD diagnoses were lower in the opioid group (RR 0.581, 0.554–0.608). Kaplan–Meier results were directionally consistent for most outcomes (Table 2)
Image 1: Long description.