Evidence map›Paper›PMID 34606956›Full record

ArticleJournal of vascular surgery2022

Opioid use in patients with peripheral arterial disease undergoing lower extremity bypass.

Ryan Howard, Jeremy Albright, Michael Englesbe, Nicholas Osborne, Peter Henke

Open access · greenAbstract readMulticenter Study
In one paragraph

Article in Journal of vascular surgery, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 1 pooled it
1.6field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.

  1. Guideline
  2. Review
  3. Review
  4. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 1 institution in 1 country.

Ryan HowardDepartment of Surgery, University of Michigan, Ann Arbor, Michigan.
Jeremy AlbrightDivision of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
Michael EnglesbeDepartment of Surgery, University of Michigan, Ann Arbor, Michigan.
Nicholas OsborneSection of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan.
Peter HenkeSection of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan. Electronic address: henke@med.umich.edu.
University of Michigan · US

Funding

Obesity Surgery Scientist Training ProgramT32DK108740 · NIDDK · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI Justin Brigham Dimick, RANDY J SEELEY · 2016 to 2026
$2.2M
Understanding Real-World Outcomes of Endovascular Treatment of ClaudicationK08HL144924 · NHLBI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI OSBORNE, NICHOLAS HAROLD · 2019 to 2023
$848k
NHLBI NIH HHS K08 HL144924NIDDK NIH HHS T32 DK108740
6 · The paper itself

Abstract

objectiveOpioid use is common among patients with peripheral arterial disease (PAD), given that pain is a defining symptom. Unfortunately, long-term opioid use places patients at dramatically increased risk of overdose and death. Although surgical revascularization is extremely effective in alleviating ischemic pain related to PAD, it is unclear whether this practice results in the discontinuation of opioids after surgery. Therefore, we conducted the following study to investigate trends in opioid use before and after surgical bypass in patients with PAD, as well as the risk factors for continued opioid use after surgery.

methodsWe conducted a retrospective analysis of patients undergoing open lower extremity bypass for claudication or rest pain between June 1, 2017, and March 31, 2021. Patients were grouped according to whether they reported preoperative opioid use at the time of surgery. The primary outcome was continued opioid use at 30-day follow-up after discharge. A multivariable logistic regression was conducted to estimate the association of continued opioid use with patient characteristics, preoperative opioid use, and receiving a postoperative opioid prescription.

resultsAmong 3873 patients undergoing surgery, the mean age was 65.7 (10.2) years and 2650 (68.4%) patients were male. There were 913 patients (23.6%) who used opioids preoperatively and hydrocodone was the most common preoperative opioid (583 [63.9%]). At discharge, 2506 patients (64.7%) received a postoperative opioid prescription. Postoperative opioid prescriptions were significantly more common for preoperative opioid users than opioid-naïve patients (813 [89.0%] vs 1693 [57.2%]; P < .001) and were significantly larger in size (24.3 [21.1] pills vs 19.9 [10.5] pills; P < .001). On 30-day follow-up, 522 preoperative opioid users (61.3%) and 616 opioid-naïve patients (28.4%) reported that they were still using opioids (P < .001). Continued opioid use at follow-up was associated with preoperative opioid use (adjusted odds ratio, 3.23; 95% confidence interval, 2.70-3.89) and receiving a postoperative opioid prescription (adjusted odds ratio, 10.83; 95% confidence interval, 7.96-15.06).

conclusionsMost patients with PAD who use opioids preoperatively do not discontinue opioids after lower extremity bypass. Moreover, a significant proportion of previously opioid-naïve patients are still using opioids 1 month after surgery. In both cases, postoperative opioid prescriptions had the strongest association with continued opioid use. These findings underscore the need for improved prescribing practice and increased attentiveness to discontinuation of unnecessary medications after surgery.

Indexed as

Vascular GraftingAdultAgedAnalgesics, OpioidDrug Administration ScheduleDrug PrescriptionsDrug UtilizationFemaleHumansIntermittent ClaudicationLower ExtremityMaleMiddle AgedPain MeasurementPeripheral Arterial DiseasePostoperative PainAnalgesics, OpioidBypassOpioidsPainPeripheral arterial diseaseSurgery

Identifiers

PMID34606956
PMCPMC9153650
OpenAlexW3202802937

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.