Patients who minimally used opioids prior to surgery, but who continued to use them for pain relief 30 days after surgery were likely to be using them in the longer term, according to a study presented here at the 2015 Annual Meeting of the Canadian Anesthesiologists’ Society (CAS).
With ongoing opioid use being a public health concern, investigators sought to examine factors that would predict continued use of opioids after surgery, choosing to study cardiac and thoracic surgical patients, regarded as having low exposure to opioids pre-operatively.
“It is rare to see a patient [in cardiac and thoracic surgery] who comes to the operating room who is using opioids,” said Peter MacDougall, MD, Atlantic Mentorship Network – Pain and Addiction, Halifax, Nova Scotia.
Dr. MacDougall and colleagues extracted cases from a provincial database in Nova Scotia, with data covering a 5-year period, and reviewed 1,028 thoracic cases and 1,333 cardiac cases. They looked at opioid use 3 months prior to surgery and up to 6 months after surgery.
More than 90% of patients did not use opioids. The strongest predictor of opioid use at 6 months post-operatively that emerged was the use of opioids at the 1-month mark after surgery.
“If you are using opioids at 1 month [after surgery], your risk of using them at 6 months is higher,” said Dr. MacDougall. “What we can say is that we should take a close look at people at the 1-month mark. If they are still on opioids at that point, we need to find root causes for the use of the opioids and make sure we are effectively treating their pain at that point.”
In the primary care setting, clinicians need to ask if patients who had surgery are continuing to take opioids, said Dr. MacDougall. “We have to assess why they are still on them,” he said.