Common surgical procedures were associated with increased risk for chronic opioid use in the first year after surgery by opioid-naïve patients and some patients were particularly vulnerable, according to a study published online by JAMA Internal Medicine.
Opioid sales have increased dramatically over the last decade, especially to relieve noncancer pain, resulting in increased opioid-related overdoses and deaths. Previous research has suggested surgery is a risk for chronic opioid use.
Eric C. Sun, MD, Stanford University School of Medicine, Stanford, California, and colleagues analysed administrative health claims data for privately insured patients: 641,941 opioid-naïve surgical patients and more than 18 million opioid-naïve nonsurgical patients for comparison.
Chronic opioid use was defined as having filled 10 or more prescriptions or more than 120 days’ supply within the first year after surgery, excluding the first 90 postoperative days because some opioid use is likely expected during that period.
The study included 11 surgical procedures: simple mastectomy, transurethral prostate resection (TURP), cataract, functional endoscopic sinus surgery (FESS), caesarean delivery, open appendectomy, laparoscopic appendectomy, open cholecystectomy, laparoscopic cholecystectomy, total hip arthroplasty (THA), and total knee arthroplasty (TKA).
The incidence of chronic opioid use in the first postoperative year ranged from 0.119% for caesarean delivery to 1.41% for TKA. For nonsurgical patients, the baseline incidence of chronic opioid use was 0.136%.
Except for cataract surgery, laparoscopic appendectomy, FESS, and TURP, all of the other surgical procedures were associated with increased risk of chronic opioid use, with some of the highest risk associated with TKA, open cholecystectomy, THA and simple mastectomy.
Patient factors associated with increased risk included being male, older than 50, and having a preoperative history of drug abuse, alcohol abuse, depression, benzodiazepine use or antidepressant use.
The study sample was limited to privately insured patients aged 18 to 64, which may make the results not generalizable to other populations.
“Our results have several clinical implications,” the authors wrote. “First, while we found that surgical patients are at an increased risk for chronic opioid use, the overall risk for chronic opioid use remains low among these patients, at less than 0.5% for most of the procedures that we examined. Thus, our results should not be taken as advocating that patients forgo surgery out of concerns for chronic opioid use. Rather, our results suggest that primary care clinicians and surgeons should monitor opioid use closely in the postsurgical period.”