Background: Earlier studies have not examined the extent to which reducing postoperative opioid use after patient discharge would improve the quality of life of opioid naïve patients, knowledge needed for economic evaluations of drugs and devices (applications) that reduce morphine milligram equivalents. We quantified associations between postoperative opioid use and patient-centered health outcomes using the EuroQol group's EQ-5D-5L values, recorded longitudinally.
Methods: Prospective observational data were collected for adult patients, without regular preoperative opioid use, undergoing inpatient surgery at 2 US hospitals in 2022-2023. Patients were enrolled before hospital discharge. On the 7th, 14th, 21st, and 28th days after discharge, smartphone-based application notifications requested survey completion, including weekly opioid use and health-related quality of life.
Results: The 606 patients had 2292 pairwise observations of EQ-5D-5L values and morphine milligram equivalents. Treating each patient as their own control, each 1-unit increase in the square root of morphine milligram equivalents was associated with a 0.0108 reduction in the EQ-5D-5L utility value (standard error 0.0011, P < .0001). If no patient had received opioids after discharge, the predicted improvement would have been a mean of 0.0436 (0.0044) EQ-5D-5L utility values per week. Sensitivity analysis #1 examined the association between mean EQ-5D-5L among weeks and mean morphine milligram equivalents among weeks while controlling for procedural specialty. Each 1-unit increase in the square root of the morphine milligram equivalents was associated with a 0.0166 (0.0026) reduction in EQ-5D-5L values (P < .0001). Sensitivity analysis #2 examined partial Kendall taub between EQ-5D-5L and morphine milligram equivalents, using the 2292 pairwise observations, controlling for baseline observations when estimating the association for week 1, controlling for week 1 observations when estimating the association for week 2, etc. The 4 Bonferroni-adjusted P ≤ .0040 showed that less opioid use was associated with greater health-related quality of life.
Conclusions: Three analyses using different assumptions showed that, among opioid naïve patients undergoing inpatient surgery, greater postoperative opioid consumption among surgical patients was associated with reduced health-related quality of life. However, the effect sizes were small, such that likely close to zero opioid intake after hospital discharge would be needed to exceed the minimal important difference. These results have implications for primary economic endpoints of future randomized trials of improved postoperative analgesia.
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