SVS Annual Meeting

PAD Patients at Risk for High Opioid Use


National efforts have intensified to reduce opioid prescriptions because of the opioid crisis. However, little is known about the relationship between peripheral arterial disease (PAD) and high-risk opioid use, according to Nathan K. Itoga, MD, of Stanford University, Calif. “As a vascular surgery resident, I wanted to know how I could do my part in reducing opioid prescriptions. However, I didn’t know if vascular patients were at risk for high opioid use. The impetus for this study was the lack of studies regarding opioid use in patients with vascular disease,” said Dr. Itoga.

Dr. Nathan K. Itoga

Dr. Itoga will present a study in Thursday’s Scientific Session 2 that he and his colleagues performed to evaluate the relationship between PAD and high opioid use and to assess whether PAD treatment impacts high opioid use.

The researchers used the 2007-2015 Truven Marketscan database, a deidentified national private insurance claims database, to identify patients with 2 ICD-9 diagnosis codes of PAD 2 months apart with at least 2 years of continuous enrollment. Critical limb ischemia (CLI) was defined as rest pain, ulcers, or gangrene.

“Our primary outcome was high opioid use, defined as 2 opioid prescriptions within a 1-year period,” said Dr. Itoga. Opioid prescriptions were excluded if filled within 90 days of a PAD-related procedure, as identified by CPT codes for lower extremity open/endovascular revascularization or amputation. A total of 182,186 patients with PAD met the inclusion criteria, 27.1% of whom had CLI. The mean follow-up was 5.29 years. An average of 24.4% of patients with PAD met the high opioid use criteria in any given calendar year, with a significant decreasing trend for patients meeting criteria beginning in 2010 (P less than .01), said Dr. Itoga. Among the high opioid users, 26.0% continued to meet the criteria for 5 years. High opioid use was found to be significantly more common for patients with CLI (32.2%) compared to PAD patients without CLI (vs. 21.4%). During years of high opioid use, an average of 5.9 yearly prescriptions was filled.

According to multivariate analysis, illicit drug use and back pain were the strongest significant predictors of high opioid use (P less than .001).

A new diagnosis of PAD significantly increased the incidence of high opioid use (21.3% before PAD diagnosis vs. 26.9% after diagnosis, P less than .01). This association with a new diagnosis of CLI increased high opioid use from 27.5% before CLI diagnosis to 37.7% after CLI diagnosis (P less than .01), highlighting the increased risk in this patient population. A total of 45,028 patients (24.7%) underwent 88,229 PAD-related procedures. After exclusion of periprocedural opioid prescriptions (18% of all opioid prescriptions), the yearly percentage of high opioid users increased from 25.6% pretreatment to 29.2% post treatment, also a significant difference (P less than .01).

“Our research shows that patients with PAD are at increased risk for high opioid use, with nearly one-quarter meeting described criteria. CLI additionally increases opioid utilization, and treatment of PAD does not appear to decrease high opioid use,” he said. “In addition to heightened awareness and active opioid management, our findings warrant further investigation into causes and deterrence of high-risk opioid use,” Dr. Itoga concluded.

Thursday, June 21, 2018
1:30 - 3:00 p.m.
HCC, Ballroom A/B
S2: Scientific Session 2

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