People who undergo certain common surgeries are more likely to use opioids chronically, even if they do not receive the analgesics for postoperative pain, according to a new study.
Researchers at Stanford University School of Medicine, in California, looked for an association between common surgical procedures and the risk for chronic use of opioids. They found that opioid-naive patients who underwent these surgeries had an increased risk for chronic opioid use, especially if they were male, elderly or had a history of depression or of drug or alcohol abuse. They reported their findings in JAMA Internal Medicine (DOI: 10.1001/jamainternmed.2016.3298).
“These are people not using opioids prior to their surgery, but a year out, now they are. That’s a striking thing,” said Eric Sun, MD, PhD, instructor of anesthesia, perioperative and pain medicine at Stanford University and lead author of the study. The study authors recommend that physicians who care for patients after surgery watch for signs of opioid abuse.
Dr. Sun and his colleagues analyzed administrative data claims of 641,941 opioid-naive surgical patients and more than 18 million opioid-naive nonsurgical patients between 2001 and 2013. The patients underwent one of 11 common surgical procedures: total knee arthroplasty (TKA), total hip arthroplasty, laparoscopic and open cholecystectomy, functional endoscopic sinus surgery, cataract surgery, laparoscopic and open appendectomy, transurethral prostate resection, cesarean delivery and simple mastectomy. Risk factors included the use of benzodiazepines, antidepressants and antipsychotics, and a history of depression, alcohol or drug abuse a year before surgery.
All surgical procedures except cataract surgery, laparoscopic appendectomy and prostate resection were associated with an increased risk for chronic opioid use. According to the study, the incidence of chronic opioid use ranged from 0.12% for cesarean delivery and 0.68% for simple mastectomy to 1.1% for open cholecystectomy and 1.4% for TKA. The baseline incidence for nonsurgical patients was 0.136%.
The authors stated that the study was limited to privately insured patients aged 18 to 64 years, which may not be representative of other populations, and that pain was not a primary indication for all of the surgical procedures observed. “More work is needed to establish the definitive causal relationship between surgery and opioid use,” the authors wrote.
According to Dr. Sun, primary care physicians should closely monitor their patients’ opioid use after surgery. He and his colleague, Beth Darnall, PhD, are currently looking into whether psychology-based therapies or regional anesthesia nerve blocks can reduce the risk for chronic opioid use among opioid-naive surgical patients.
“It’s important for primary care providers to keep an eye on their surgical patients to see what they’re doing opioid-wise,” Dr. Sun said. “We need more research on what we can do to reduce this risk.”