About 6% of previously opioid-naive patients continued to use opioids more than three months after both major and minor elective surgical procedures, a recent study found.
Researchers used administrative health claims from Jan. 1, 2012, to June 30, 2015, among a cohort of privately insured adults ages 18 to 64 years who had surgery between 2013 and 2014. The 36,177 patients had filled opioid prescriptions either in the month before surgery or within two weeks of discharge but not in the 11 months prior to surgery.
Patients underwent 13 common elective surgical procedures, with 29,068 (80.3%) having minor procedures (varicose vein removal, laparoscopic cholecystectomy, laparoscopic appendectomy, hemorrhoidectomy, thyroidectomy, transurethral prostate surgery, parathyroidectomy, and carpal tunnel release) and 7,109 (19.7%) having major procedures (ventral incisional hernia repair, colectomy, reflux surgery, bariatric surgery, and hysterectomy). For comparison, researchers used a sample of 492,177 patients who did not have surgery during the study period but were given a random date of fictitious surgery.
The primary outcome was new persistent opioid use, defined as filling an opioid prescription between 90 and 180 days after surgery. Results were published online on April 12 by JAMA Surgery.
In the minor surgery group, 1,711 patients (5.9%) filled an opioid prescription between 90 and 180 days versus 465 (6.5%) in the major surgery group (odds ratio, 1.12; 95% CI, 1.01 to 1.24). Only 1,779 (0.4%) of patients in the nonsurgical group did so.
There were small variances in the incidence of new persistent opioid use across procedures (range, 4.5% to 9.9%). However, after adjustment for sociodemographic and clinical preoperative covariates, the difference between patients having minor and major procedures was no longer significant.
Regardless of surgical procedure, risk factors associated with new persistent opioid use were history of tobacco use (P<0.001), alcohol and substance use disorders (P=0.02), and comorbid conditions (P<0.001). Patients who filled an opioid prescription in the 30 days before surgery were nearly twice as likely to have persistent opioid use after surgery (adjusted odds ratio, 1.93; 95% CI, 1.71 to 2.19; P<0.001).
These results suggest that “Prolonged opioid use can be deemed the most common postsurgical complication,” the study authors wrote. They noted limitations, such as how they did not capture actual opioid consumption or use of opioids obtained without a prescription. They added that results may not be generalizable to uninsured patients or those ages 65 years and older.