Predictive Factors for Postoperative Opioid Use in Elective Skull Base Craniotomies

Tamia Potter; Pranay Soni; Maria Krywyj; Derrick Obiri-Yeboah; Precious Oyem; Arbaz Momin; Kathryn Easley; Pablo F. Recinos; Varun R. Kshettry

doi:10.1055/s-0042-1744452

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2022; 83(06): 594-601
DOI: 10.1055/s-0042-1744452

Review Article

Predictive Factors for Postoperative Opioid Use in Elective Skull Base Craniotomies

Tamia Potter

¹Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

²Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

,

Pranay Soni

²Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

,

Maria Krywyj

²Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

,

Derrick Obiri-Yeboah

²Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

³Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States

,

Precious Oyem

²Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

³Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States

,

Arbaz Momin

²Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

³Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States

,

Kathryn Easley

²Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

,

Pablo F. Recinos

²Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

³Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States

,

Varun R. Kshettry

²Department of Neurological Surgery, Rosa Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States

³Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, United States

› Author Affiliations

Abstract

Objective In 2017, the United States officially declared opioid overuse a public health emergency. Due to a paucity of published benchmark data in skull base neurosurgery, we quantified postoperative opioid use in patients undergoing skull base craniotomies and identified factors that influence postoperative opioid use.

Setting Tertiary academic medical center.

Participants Patients who underwent elective craniotomies by two skull base neurosurgeons between January 2015 and May 2020.

Main Outcome Measures Demographic and perioperative data were retrospectively extracted from the electronic medical record. Surgical approaches were categorized as having either “significant” or “minimal” muscle dissection. Univariate and multivariate linear regression analyses were performed to identify predictors of postoperative opioid use at 24, 48, and 72 hours.

Results We included 300 craniotomies, 206 were supratentorial and 94 were infratentorial. This included 195 women and 105 men, with a mean age of 54.9 years. In multivariable analysis, a history of anxiety or depression, preoperative opioid use, and a history of migraines independently predicted a significantly greater opioid use at 24, 48, and 72 hours. Increased age and minimal muscle dissection independently predicted lower opioid consumption. Sex, infratentorial versus supratentorial approach, length of surgery, and postoperative steroid use did not impact total opioid use.

Conclusion Younger age, history of anxiety or depression, preoperative opioid consumption, preexisting history of migraines, and significant intraoperative muscle dissection were associated with higher postoperative opioid consumption. These risk factors provide insight on potential targets for minimizing postoperative opioids in craniotomies.

Keywords

opioid - craniotomy - skull base - pain

Full Text

References

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