353: The effect of risk factors and sex on acute post-surgical opioid use

Topic: Clinical Science
Subtopic: Non-specific to any diagnosis, Psychology, Gender/sex differences, Treatment/management

Background and Aims: Opioids continue to be prescribed for acute post-surgical pain management, posing a risk for persistent opioid use (1). In an opioid-sparing context, we identified risk factors predictive of acute opioid rescue medication use 1-2 days after surgery (2). Sex differences in perioperative reports of affect and pain intensity (3), as well as opioid consumption and efficacy (4) may affect this acute window of post-surgical opioid use. We aimed to investigate sex differences in known factors affecting acute opioid use two days after surgery. We hypothesized that the known risk factors predicting opioid use would differ by sex.

Methods: Norwegian-speaking patients undergoing surgery provided written informed consent to procedures approved by the Regional Committees for Medical and Health Research Ethics. Patients reported affect and pain before and after surgery and opioid use 2 days later. To identify predictors of postoperative opioid use, we performed a multimodel inference (5) which ran binary logistic regression models of all possible combinations of previously identified risk factors. Akaike weights from Akaike information criteria (AIC) were used to calculate the most important and significant predictors across models. Separate inference was run for males and females. Significance was set at p < 0.05.

Results: Our sample comprised of 909 patients between 18-85 years of age with and without various types of chronic pain. In males (n = 281), age (odds ratio = 0.96, p < 0.001) and pre-surgical pain intensity (odds ratio = 2.15, p < 0.01) were the strongest predictors of opioid use. In females (n = 628), pre-surgical pain intensity (odds ratio = 1.38, p < 0.0001), pre-surgical pain catastrophizing scores (odds ratio = 1.05, p < 0.05), and post-surgical coping with pain (odds ratio = 0.87, p < 0.0001) were the strongest predictors of opioid use.

Conclusions: We report evidence of common and differing risk factors predicting acute post-surgical opioid use between sexes. While pre-surgical pain intensity was a common predictor between males and females, female risk factors were state-related and both pre- and post-surgical, while the differing risk factor in males was trait-related (age). Future studies should continue to investigate these differences in males and females to personalize post-surgical care and further identify factors that may reduce the risk of persistent opioid use.

References: 1. Ervin-Sikhondze, B. A. et al. Opioid consumption in the first 30 days after surgery was independently associated with new persistent opioid use. Reg. Anesth. Pain Med. https://doi.org/10.1136/rapm-2024-106068 (2024) doi:10.1136/rapm-2024-106068.
2. Meier, I. M. et al. Factors associated with use of opioid rescue medication after surgery. Reg. Anesth. Pain Med. 49, 265–271 (2024).
3. Eikemo, M. et al. Opioid analgesic effects on subjective well‐being in the operating theatre*. Anaesthesia 78, 1102–1111 (2023).
4. Gerbershagen, H. J. et al. Procedure-specific Risk Factor Analysis for the Development of Severe Postoperative Pain. Anesthesiology 120, 1237–1245 (2014).
5. Formal Inference From More Than One Model: Multimodel Inference (MMI). in Model Selection and Multimodel Inference (eds Burnham, K. P. &amp; Anderson, D. R.) 149–205 (Springer New York, New York, NY, 2004). doi:10.1007/978-0-387-22456-5_4.

Presenting Author: Georgia E. Hadjis
Submitting Author: Georgia Hadjis

Senior Author: Siri Leknes

IASP 2026 Global Year theme of Neuropathic Pain: No

• Georgia E. Hadjis: PhD - University of Oslo
• Martin Trøstheim: MSc - University of Oslo
• Marie Eikemo: PhD - University of Oslo
• Siri Leknes: PhD - University of Oslo