Pre-admission Opioid Use and Associated Outcomes in Patients Revascularised for Lower Peripheral Artery Disease

OBJECTIVE: This nationwide, retrospective, registry study aimed to evaluate the rate of continued opioid use after revascularisation in patients with lower extremity peripheral artery disease (PAD) and the association between opioid treatment and post-discharge mortality.

METHODS: Using Danish national registries, all patients undergoing first time endovascular or surgical revascularisation for PAD (1996 - 2018) were identified. Patients were categorised based on opioid use before admission: current new users (first time opioid prescription within 30 days before admission); current long term users (opioid prescription both before and within 30 days before admission); recent users (prescription within 31 - 365 days before admission); former users (prescription more than 1 year before); and non-users (no history of opioid prescription). Outcomes post-discharge were analysed using multivariable Cox regression.

RESULTS: Among 40 186 patients (median age 70 years, 54% men) surviving revascularisation, 5.4% were current new users, 22.9% current long term users, 14.5% recent users, 19.0% former users, and 38.2% non-users. A higher proportion of opioid users presented with chronic limb threatening ischaemia. Within 3 months post-discharge, opioid prescription refills were highest among current long term users (76.7%) and lowest among non-users (14.6%). Compared with non-users, the 1 year adjusted hazard ratio for all cause mortality was 1.64 (95% confidence interval [CI] 1.44 - 1.86) for current new users, 1.59 (95% CI 1.46 - 1.74) for current long term users, and 1.13 (95% CI 1.03 - 1.26) for recent users, with no increased risk for former users.

CONCLUSION: This nationwide study identified a high risk subgroup of PAD patients with substantial opioid use and elevated mortality risk. Despite revascularisation, many with prior opioid use continued treatment post-discharge, highlighting the need for cautious prescribing and structured follow up to manage persistent pain and complex care needs. Although causality cannot be confirmed, pre-revascularisation opioid use was associated with a higher all cause mortality rate, probably reflecting greater disease severity.