Background: 

Most individuals undergoing elective surgery expect to discontinue opioid use after surgery, but many do not. Modifiable risk factors including psychosocial factors are associated with poor postsurgical outcomes. We wanted to know whether pain catastrophizing is specifically associated with postsurgical opioid and health-care use.

Methods: 

This was a longitudinal cohort study of trial participants undergoing elective spine (lumbar or cervical) or lower-extremity (hip or knee osteoarthritis) surgery between 2015 and 2018. Primary and secondary outcomes were 12-month postsurgical days’ supply of opioids and surgery-related health-care utilization, respectively. Self-reported and medical record data included presurgical Pain Catastrophizing Scale (PCS) scores, surgical success expectations, opioid use, and pain interference duration.

Results: 

Complete outcomes were analyzed for 240 participants with a median age of 42 years (34% were female, and 56% were active-duty military service members). In the multivariable generalized additive model, greater presurgical days’ supply of opioids (F = 17.23, p < 0.001), higher pain catastrophizing (F = 1.89, p = 0.004), spine versus lower-extremity surgery (coefficient estimate = 1.66 [95% confidence interval (CI), 0.50 to 2.82]; p = 0.005), and female relative to male sex (coefficient estimate = −1.25 [95% CI, −2.38 to −0.12]; p = 0.03) were associated with greater 12-month postsurgical days’ supply of opioids. Presurgical opioid days’ supply (chi-square = 111.95; p < 0.001), pain catastrophizing (chi-square = 96.06; p < 0.001), and lower extremity surgery (coefficient estimate = −0.17 [95% CI, −0.24 to −0.11]; p < 0.001), in addition to age (chi-square = 344.60; p < 0.001), expected recovery after surgery (chi-square = 54.44; p < 0.001), active-duty status (coefficient estimate = 0.58 [95% CI, 0.49 to 0.67]; p < 0.001), and pain interference duration (chi-square = 43.47; p < 0.001) were associated with greater health-care utilization.

Conclusions: 

Greater presurgical days’ supply of opioids and pain catastrophizing accounted for greater postsurgical days’ supply of opioids and health-care utilization. Consideration of several modifiable factors provides an opportunity to improve postsurgical outcomes.

Level of Evidence: 

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

中文翻译：

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疼痛灾难性预测骨科手术后阿片类药物和医疗保健的使用：对脊柱和下肢疾病试验参与者的二次分析

背景： 

大多数接受择期手术的人希望在手术后停止使用阿片类药物，但许多人并没有这样做。包括心理社会因素在内的可改变的风险因素与不良的术后结果有关。我们想知道灾难性疼痛是否与术后阿片类药物和医疗保健使用特别相关。

方法： 

这是一项纵向队列研究，受试者在 2015 年至 2018 年期间接受选择性脊柱（腰椎或颈椎）或下肢（髋关节或膝关节骨关节炎）手术。主要和次要结果是术后 12 个月的阿片类药物供应和手术-相关的医疗保健利用，分别。自我报告和医疗记录数据包括术前疼痛灾难化量表 (PCS) 评分、手术成功预期、阿片类药物使用和疼痛干扰持续时间。

结果： 

对 240 名中位年龄为 42 岁的参与者（34% 为女性，56% 为现役军人）的完整结局进行了分析。在多变量广义相加模型中，术前阿片类药物供应量更大（F = 17.23，p < 0.001），灾难性疼痛更高（F = 1.89，p = 0.004），脊柱与下肢手术（系数估计 = 1.66 [95 % 置信区间 (CI)，0.50 至 2.82]；p = 0.005)，女性相对于男性（系数估计 = -1.25 [95% CI，-2.38 至 -0.12]；p = 0.03）与更大的 12 - 术后一个月的阿片类药物供应量。术前阿片类药物天数供应（卡方 = 111.95；p < 0.001）、灾难性疼痛（卡方 = 96.06；p < 0.001）和下肢手术（估计系数 = -0.17 [95% CI，-0.24 至 - 0.11]；p < 0.001),

结论： 

更多的术前阿片类药物供应和疼痛灾难性导致更多的术后阿片类药物供应和医疗保健使用。考虑几个可修改的因素为改善术后结果提供了机会。

证据等级： 

预后等级 III。有关证据级别的完整描述，请参见作者说明。