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Opioid use elevated in patients with PAD, CLI

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Nathan Itoga

Patients with peripheral artery disease and critical limb ischemia had an increased risk for opioid use, according to data presented at the Society for Vascular Surgery Vascular Annual Meeting.

Nathan Itoga, MD, vascular surgery resident at Stanford University, and colleagues analyzed data from 182,186 patients with PAD from a database between 2007 and 2015. All patients had two or more diagnoses of PAD at least 2 months apart. Patients with CLI were also included (27.1%), with CLI defined as ulcers, rest pain or gangrene.

The primary outcome of interest was high opioid use, defined as more than two opioid prescriptions within 1 year. Prescriptions within 90 days of a procedure for PAD were excluded.

During a mean follow-up of 5.29 years, 24.4% of patients met the criteria for high opioid use. The number of patients who met the criteria decreased starting in 2010 (P < .01).

Opiod use more likely among patients with peripheral artery disease and critical limb ischemia

Source: Shutterstock

Of the patients who met the criteria for high opioid use, 26% met the criteria for 5 years. Compared with those without CLI, those with the condition were more likely to have high opioid use (32.2% vs. 21.4%; P < .01).

The strongest predictors of high opioid use were back pain and illicit drug use (P < .001). High opioid use increased from before a PAD diagnosis to after the diagnosis (21.3% to 26.9%; P < .01). This was seen in patients with (27.5% to 37.7%; P < .01) and without CLI (20.2% to 24.1%; P < .01).

Among 45,028 patients who underwent a PAD-related procedure — whether an open revascularization, an endovascular revascularization or an amputation — the annual percentage of high opioid users increased from before treatment to after treatment (25.6% to 29.2%; P < .01).

“In addition to heightened awareness and active opioid management, our findings warrant further investigation into causes and deterrence of high-risk opioid use,” Itoga and colleagues wrote in an abstract. – by Darlene Dobkowski

Reference:

Itoga N, et al. S2: Scientific Session 2. Presented at: Society for Vascular Surgery Vascular Annual Meeting; June 20-23, 2018; Boston.

Disclosure: Itoga reports no relevant financial disclosures.