Leftover opioids following adult surgical procedures: a systematic review and meta-analysis

Schirle, Lori; Stone, Amanda L.; Morris, Matthew C.; Osmundson, Sarah S.; Walker, Philip D.; Dietrich, Mary S.; Bruehl, Stephen

doi:10.1186/s13643-020-01393-8

Systematic Reviews

Table 1 Studies included in meta-analysis

From: Leftover opioids following adult surgical procedures: a systematic review and meta-analysis

Study	Surgery type	Sample size	Mean (age)	Female (%)	Sample with pre-operative opioid use (%)	Region	Opioid outcome	Method	Postop day	Risk of bias
Alter and Ilyas [48]	Carpel tunnel release	20	62	70	0	Midwest	Pills	Mean	3	L
As-Sanie, et al. [49]	Hysterectomy	102	49	100	12	Midwest	MME	Median	14	L
	Minimally invasive	86
	Open	16
Bateman, et al. [8]	Cesarean section	615	33	100		Multiple	Pills	Median	14	L
Bates et al. [50]	Urologic surgery	226				West	Pills	Mean	28	M
Beck et al. [51]	ACL reconstruction	125	33.5	48		Midwest	Pills	Mean	7	M
Cabo et al. [52]	Urologic surgery	77	62.9	35	16	South	MME	Median	21	M
Chapman et al. [53]	Carpal tunnel release	277	64.6	56		Northeast	Pills	Mean	--	H
Cunningham et al. [54]	Hip arthroscopy	73	36.5	75	22	South	Pills and MME	Mean	42	L
Fujii et al. [4]	Various surgeries	333	58			Northeast	MME	Median	7	M
	Partial mastectomy;	21	62.9	96	0
	Umbilical hernia repair (open)	16	49	42	5
	Appendectomy (lap)	17	41.6	56	0
	Cholecystectomy (lap)	40	51.3	70	2.5
	Inguinal hernia repair (open)	25	59.5	0	0
	Carpal tunnel release	28	60.8	63	0
	Knee arthroscopy	30	42	47	3
	Shoulder arthroscopy	23	57.4	36	12
	Total hip arthroplasty	45	61.3	48	20
	Total knee arthroplasty	31	65	56	6
	Vasectomy	11	38.8	0	0
	Endoscopy	29	58.5	48	19
	Prostatectomy (lap)	17	62.8	0	0
Griffith et al. [55]	Hysterectomy	53				Northeast	Pills	Mean	300	M
	Minimally invasive	39	60.6	100
	Open	14	32	100
Gupta et al. [56]	Foot and ankle surgery	84	47	66	0	Northeast	Pills	Mean	14	M
Harris et al. [57]	Dermatologic surgery	212	68	28		West	Pills	Mean	4	M
Hart et al. [58]	Breast surgery	95	60.4	100		South	Pills	Mean	30	H
Hartford et al. [59]	Abdominal surgery	171	50	47		Canada	Pills and MME	Mean	21	L
	Cholecystectomy (lap)	84
	Open hernia repair	87			0
Hill et al. [5]	Various surgeries	127			0	Northeast	Pills	Median	--	M
	Partial mastectomy	20			0
	Partial mast/node biopsy	21			0
	Cholecystectomy (lap)	48			0
	Inguinal hernia repair (lap)	20			0
	Inguinal hernia repair (open)	18			0
Hill et al. [60]	Various surgeries	234		63	0	Northeast	Pills	Mean	--	M
	Bariatric	83			0
	Foregut	33			0
	Hepatectomy	12			0
	Pancreatectomy	10			0
	Colectomy	69			0
	Ventral hernia	27			0
Hota et al. [61]	Gynecologic and pelvic reconstructive surgery	51	53	100		Northeast	Pills	Median	14	M
	Major	2
	Minor	49
Howard, Fry et al. [6]	Various surgeries	2392				Midwest	Pills and MME	Median	30-120	M
	Cholecystectomy (lap)	603	51.2	71
	Appendectomy (lap)	224	44.6	53
	Inguinal and femoral hernia repair (open or lap)	659	58	19
	Open incisional hernia repair	159	60.1	57
	Colectomy (lap)	112	63.5	56
	Open colectomy	102	64.7	55
	Ileostomy and colostomy takedown	59	57.9	42
	Small-bowel resection and/or enterolysis	33	68	58
	Thyroidectomy	40	56	83
	Vaginal hysterectomy	113	51.7	100
	Hysterectomy (lap)	203	49.7	100
	Abdominal hysterectomy	85	51.5	100
Howard, Waljee et al. [62]	Cholecystectomy (lap)	100	46	78		Midwest	Pills and MME	Median	< 365	H
Ilyas et al. [63]	Carpal tunnel release	37				Northeast	Pills	Mean	5	L
	Minimally invasive	19	59	42	0
	Open	18	61	67	0
Kim et al. [15•]	Upper extremity surgery	1392	56	55		Northeast	Pills	Mean	Postop visit	L
	Bone	499
	Soft tissue	893
Kumar et al. [64]	Shoulder surgery	62	48	26	0	Northeast	Pills	Mean	90	L
Maughan et al. [65]	Dental surgery	72	28	61	0	Northeast	Pills and MME	Median	21	M
Merrill et al. [66]	Foot and ankle surgery	132	53.2	62	0	South	Pills	Mean	10	M
	Bone	91
	Soft tissue	41
Miller et al. [67]	Carpal tunnel release	159	59.4	56	0	Northeast	Pills	Mean	--	M
Osmundson et al. [68]	Cesarean section	179	31	100		South	Pills and MME	Median	14	M
Osmundson et al. [9]	Cesarean section	85	30	100		South	Pills and MME	Median	14	L
Patel HD et al. [69]	Radical prostatectomy	205				South	MME	Mean	30	L
	Minimally invasive	149	61.5	0
	Open	56	61.2	0
Patel S et al. [70•]	Rhinoplasty	62				Multiple	Pills	Mean	5	M
Peters et al. [71]	Carpal tunnel release	49	57	66	0	Canada	Pills	Mean	84	M
Riley et al. [72]	Rhinologic surgery	42	48.6	33	2.4	Northeast	MME	Median	14	M
Rodgers et al. [73]	Upper extremity surgery	249	54	67	0	Midwest	Pills	Mean	14	M
	Bone	58
	Soft tissue	191
Sabatino et al. [74]	Orthopedic procedures	557				Northeast	Pills	Mean	14	M
	Total hip arthroplasty	198	65	52	19
	Total knee arthroplasty	146	65.7	56	17
	Carpal tunnel release	91	59.6	58	15
	Rotator cuff repair	72	60.6	32	17
	Lumbar decompression	50	65.6	48	20
Saini et al. [75•]	Foot and ankle surgery	988	49	62	0	Northeast	Pills	Median	14	M
	Bone	754
	Soft tissue	234
Schmidt et al. [76]	Cesarean section	141	32	100		Midwest	Pills	Median	14	M
Solouki et al. [77]	Urogynecologic surgery	143	59.5	100	12.6	Northeast	Pills	Mean	30	M
Stepan, et al. [78]	Hand surgery	54	54.9	57	0	Midwest	MME	Mean	7	L
Swarup et al. [79]	Anorectal surgery	23		48	0	Northeast	Pills	Median	14	M
Swenson et al. [80]	Urogynecologic surgery	50	63	100	20	Midwest	Pills	Median	14	M
Tan et al. [81]	Abdominal procedures	176	60.4	50	0	Midwest	MME	Median	26	M
	Minimally invasive	123
	Open	53
Tharakan et al. [82]	Thyroidectomy and parathyroidectomy	89	55	82		Northeast	Pills	Median	42-730	M
Thiels, et al. [83]	Various surgeries	2486				Multiple	MME	Median	28	M
	Carotid endarterectomy	73	73	37
	Parathyroidectomy	108	67.5	83
	Arteriovenous fistula creation	63	68	47
	MIS partial colectomy with anastomosis	70	62	68
	Carpel tunnel release	128	65	100
	Breast lumpectomy	111	65	58
	MIS cholecystectomy	138	64	16
	MIS inguinal hernia repair	107	65	100
	Ovarian cancer cytoreduction	58	62	6
	Open inguinal hernia repair	109	70	97
	Simple mastectomy	76	67.5	100
	MIS hysterectomy;	139	56	36
	MIS low anterior resection;	25	59	0
	MIS prostatectomy	105	62	39
	MIS nephrectomy	100	65	47
	Knee arthroscopic meniscectomy	112	49	45
	Open pancreaticoduodenectomy	40	65.5
	MIS lung wedge resection	110	64.5	49
	Tonsillectomy	60	31	70
	Rotator cuff surgery	129	61	36
	Lumbar Laminotomy/laminectomy	91	60	32
	Open lung lobectomy	43	66	49
	Lumbar fusion	75	59	41
	Total hip arthroplasty	202	67	48
	Total knee arthroplasty	214	69	53
Weiland et al. [84•]	Third molar extraction	48	19.6	67		Northeast	Pills	Median	7	M
Wojahn et al. [85•]	Knee arthroscopy	221	46.2	48	2.7	Midwest	Pills	Median	42	L

Risk of bias scores based on MINORS tool [19]. Studies were rated on 8 categories: (1) clearly stated aim, (2) inclusion of consecutive patients, (3) prospective collection of data, (4) endpoints appropriate to aim or study, (5) unbiased assessment of study endpoint, (6) follow-up period appropriate to aim of study, (7) loss to follow-up rate (adapted to < 20% based on typical study endpoints), and (8) prospective calculation of study size. We added a 9th category, assessment methodology to further adapt the instrument for use for this project. Each category received a 0-2 score. On this scale, 0—not reported, 1—reported, but inadequate, and 2—reported and adequate. Thus, each study received a score between 0-18. Risk of bias categories were assigned based on tertiles: high (H), 0-5; moderate (M), 6-12; low (L), 13-18

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