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Postoperative opioid prescribing patients with diabetes: Opportunities for personalized pain management.

Zammit A, Coquet J, Hah J, El Hajouji O, Asch SM, Carroll I, Curtin CM, Hernandez-Boussard T. Postoperative opioid prescribing patients with diabetes: Opportunities for personalized pain management. PLoS ONE. 2023 Aug 24; 18(8):e0287697.

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BACKGROUND: Opioids are commonly prescribed for postoperative pain, but may lead to prolonged use and addiction. Diabetes impairs nerve function, complicates pain management, and makes opioid prescribing particularly challenging. METHODS: This retrospective observational study included a cohort of postoperative patients from a multisite academic health system to assess the relationship between diabetes, pain, and prolonged opioid use (POU), 2008-2019. POU was defined as a new opioid prescription 3-6 months after discharge. The odds that a patient had POU was assessed using multivariate logistic regression controlling for patient factors (e.g., demographic and clinical factors, as well as prior pain and opiate use). FINDINGS: A total of 43,654 patients were included, 12.4% with diabetes. Patients with diabetes had higher preoperative pain scores (2.1 vs 1.9, p < 0.001) and lower opioid naïve rates (58.7% vs 68.6%, p < 0.001). Following surgery, patients with diabetes had higher rates of POU (17.7% vs 12.7%, p < 0.001) despite receiving similar opioid prescriptions at discharge. Patients with Type I diabetes were more likely to have POU compared to other patients (Odds Ratio [OR]: 2.22; 95% Confidence Interval [CI]:1.69-2.90 and OR:1.44, CI: 1.33-1.56, respectively). INTERPRETATION: In conclusion, surgical patients with diabetes are at increased risk for POU even after controlling for likely covariates, yet they receive similar postoperative opiate therapy. The results suggest a more tailored approach to diabetic postoperative pain management is warranted.

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