Introduction: The rate of opioid prescription has increased substantially over the last few years (2, 3) to manage acute pain after the surgery (1). Surgeons are one of the high opioid prescriber among various specialties (4).
According to Clarke et al approximately 50% surgical patients are discharged on opioid prescription (6); out of which 3-10% of the patients continue to take prescribed opioids beyond 90 days after the surgery (5, 6). Prolong opioid use is not only reported after major surgeries as patients 7-10% of the patients prescribed opioid with seven days of low risk surgery are reported to take opioid after 90 days (16). Persistent opioid use after the surgery is associated with increased socioeconomic burden, morbidity (7), and mortality (6, 8). Patients who consumed opioids for longer duration may require higher opioid doses (9) and are at risk of opioid abuse or misuse (10) or to develop hyperalgesia (11). Current guidelines recommend detailed screening of a patient prior to prescribing opioids (12).Most studies explored the risk factors associated harmful behaviors in chronic noncancer pain patients (13, 14); whereas fewer studies explored the factors associated with prolong opioid use after the surgery (4, 15 -17). Studies that explored the association of risk factors with prolonged opioid use used variable definition for prolong opioid use (90 vs. 180 days) or explored risk of opioid use in specific surgical conditions such as knee arthritis (6).
Previous studies have reported various baseline characteristics such as co morbidities, and psychological conditions are associated with the persistent opioid use after the surgery (6, 20). However, these studies also showed lack of consistency regarding the risk factors associated with the persistent opioid use after the surgery. Clinical significance: Managing acute pain after the surgery remains challenging. Not optimally managed pain can delay the hospital discharge (18), slows the rehabilitation process (19) and predispose to the development of persistent post surgical pain. Currently there is paucity of evidence to identify factors associated with prolong opioid use after the surgery. This frustrates the effort to identify, which patients will develop the persistent use of opioid after the surgery. Results of our systematic review will be of importance to multiple stake-holders such as pain physician, surgeons, family physicians, patients and insurers.
Our results will allow surgeons to screen high risk patient and to provide education to patients about the risk and benefits about opioids to manage acute pain after the surgery. Identifying high risk patients will allow surgeons to establish multimodal treatment plan for high risk patients and thus reducing the health care cost and burden. Research Objectives: As opioid use has increased dramatically over the last few decades, it is important to explore what patient characteristics predispose patients to prolong opioid use after the surgery. Our goal is to explore the prevalence of persistent opioid use in previously opioid naïve patients after the surgery and what risk factors are associated with the persistent opioid use after the surgery. Methods: We will register out protocol with PROSPERO (www.
crd.york.ac.uk/PROSPERO/). We will conduct this study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (21). Literature search strategy: We will conduct broad literature search in collaboration with the experienced librarian using the data bases MEDLINE, PsychINFO, EMBASE and CINAHL from the inception of those data bases to the January 2018. We have identified four eligible articles (REF) as a validation articles.
We will use the Pub Med Id’s of the validation articles to determine key words using the “Yale Mesh Word Analyzer”. We will also search the published systematic reviews to find the possible eligible studies for our systematic review. The key words in the search strategy will be stratified in to three categories, namely study design, opioid use, and surgery. The keywords within each category will be combined by using “OR” whereas all the three categories will be combined by “AND”.