Single-Center Hospital and Outpatient Opioid Use for Lower Extremity Arterial Disease
Authors: Fan Xuanjia , Graziane Nicholas M. , Ramirez Maria C. , Stella Salvatore L. , Karunanayaka Prasanna , Ruiz-Velasco Victor , Adhikary Sanjib , Flohr Flohr 
Published: April 2024

ABSTRACTIntroductionThe pain associated with lower extremity arterial disease is difficult to treat, even with lower extremity revascularization. We sought to evaluate in-hospital and post-operative opioid usage in patients with different disease severities and treatments for lower extremity vascular disease.MethodsA retrospective review was performed for all hospital encounters for patients with an International Classification of Diseases (ICD) code consistent with lower extremity arterial disease admitted to single center between January 2018 and March 2023. Encounters were subdivided according to patient’s disease severity, treatment type as designated by Current Procedural Terminology (CPT) code and comorbid diagnosis of diabetes mellitus. These groups were analyzed for in-hospital opioid use frequency and dosage. Encounters for patients admitted with a secondary diagnosis of lower extremity atherosclerotic disease were included as the control group (CON). A total of 438 patients represented by all the analyzed encounters were then reviewed for number and type of vascular procedures performed as well as opioid use in the outpatient setting for one year.ResultsCritical limb ischemia (CLI) encounters were more likely to use opioids as compared CON and peripheral arterial disease (PAD) without rest pain, ulcer or gangrene groups (CLI 67.9% versus CON 52.1%,p< 0.001 and CLI 67.9% versus PAD 50.2%,p< 0.001). Opioid use was also more common in encounters for gangrene and groups treated with revascularization (REVASC) and amputation (AMP) as compared to CON (gangrene 74.5% versus CON 52.1%,p< 0.01; REVASC 58.3% versus CON 52.1%,p=0.01; and AMP 72.3% versus CON 52.1%,p< 0.01). Significantly increased opioid doses per day (MME/day) were not noted for any of the investigated groups as compared to CON. In the outpatient setting, 186 (42.5%) patients were using opioids one month after the most recent vascular intervention. By one year, 31 (7.1%) patients were still using opioids. No differences in opioid usage were noted for patients undergoing single versus multiple vascular interventions at one year. Patients undergoing certain vascular surgery procedures were more likely to be using opioids at one year.ConclusionPatients with CLI and gangrene as well as those undergoing vascular treatment have a greater frequency of opioid use during hospital encounters as compared those patients with less severe disease and undergoing conservative management, respectively. However, these findings do not equate to higher doses of opioid used during hospitalization. Patients undergoing multiple vascular procedures are not more likely to be using opioid long-term (at one year) as compared to those patients treated with single vascular procedures.ARTICLE HIGHLIGHTSType of ResearchA single-center, retrospective reviewKey FindingsPatients with critical limb ischemia during hospitalization use opioids more frequently than patients with less severe vascular disease. These findings do not equate to higher doses of opioid used during hospitalization. Patients with lower extremity arterial disease undergoing multiple vascular procedures are not more likely to be using opioids long-term (at one year) as compared to patients treated with single vascular procedures.Take Home MessageThe pain associated with lower extremity arterial occlusive disease often requires treatment with opioids, however, disease severity and numerous treatments do not equate with the need for increased or prolonged dosage.