Study Shows Opioid Dependence Has No Impact on TPIAT Outcomes

Patients with chronic pancreatitis can exhibit dependence on chronic opioid therapy prior to receiving total pancreatectomy with islet autotransplantation.

According to research presented at the American College of Gastroenterology (ACG) 2020 conference, there was no apparent effect or influence of opioid dependence on total pancreatectomy with islet autotransplantation (TPIAT) outcomes.

However, many chronic pancreatitis patients receiving the surgical procedure have shown dependence on chronic opioid therapy.

A team led by Aws Alameri, MD, at the University of Texas Health Center at San Antonio, collected data from the National Inpatient Sample (NIS), the largest all-payer inpatient database in the United Stated. The data represented patients between 2008-2014 who were >18 years, admitted for chronic pancreatitis, and who underwent TPIAT.

The team measured mortality, length of stay, and cost of hospitalization among patients that were opioid dependent and those who were not.

Thus, they assessed a total of 990 patients. Of the population, the team identified 67 patients who had a diagnosis of opioid abuse of dependence.

The overall median age was 42, with median ages in the opioid dependance group and non-dependence groups being 48 and 42, respectively.

Women constituted a majority of patients that underwent TPIAT in both groups—76.9% in the opioid cohort and 64.0% in the non-dependence cohort.

“Surprisingly the majority of opioid dependence patients that underwent TPIAT were on the western part of the US [85.2%] and none were in the Midwest or Northeast,” they wrote.

They also noted that there were 2 deaths among those not dependent on opioid therapy, and none among those with dependence. However, it was noted these findings were not statistically significant.

Additionally, the length of hospital stay was higher among patients without opioid abuse (median, 12 days) in comparison to those with opioid abuse (11 days). It was also reported that the cost of hospitalization was higher in the former group ($68,938) than the latter ($60,412). And yet, both of these findings were also considered statistically significant.

Overall, the investigators concluded that opioid dependence does not seem to play a role in outcomes in patients undergoing TPIAT.

“This is promising and may be an impetus to consider performing the surgery in patients with chronic pancreatitis and opioid dependence,” they wrote.

They acknowledged that their retrospective study is limited in that it could not provide insight into long term outcomes for these kinds of patients.

The opioid epidemic remains a critical concern for physicians and healthcare providers treating patients with acute and chronic pain. During the coronavirus disease 2019 (COVID-19) pandemic, opioid abuse and related deaths have seen significant increases.

In terms of implications and next steps for this study, Alameri and colleagues noted that it would be necessary to undertake prospective studies in order to make the appropriate surgical/treatment choices for such patients who must deal with the pain of chronic pancreatitis.

The study, “Opioid Dependence and Outcomes in Total Pancreatectomy with Islet Autotransplantation in Patients With Chronic Pancreatitis,” was presented at ACG 2020.