Certain Surgeries Linked to Greater Risk of Chronic Opioid Use

For opioid-naive patients, many surgeries are associated with a higher risk of chronic opioid use in the postoperative period with certain patients being more vulnerable, a study in JAMA Internal Medicine has found.

Chronic opioid use adds a significant burden on economic costs and morbidity. However, not much is known if opioid-naive patients undergoing surgery have an increased risk of chronic opioid use, as well as potential risk factors for chronic use after surgery. 

Eric C. Sun, MD, PhD, from Stanford University School of Medicine, and colleagues performed a retrospective analysis to characterize the risk of chronic opioid use among opioid-naive patients after 1 of 11 surgical procedures vs. non-surgical patients. They examined administrative health claims to determine the connection between chronic opioid use and surgery among privately insured patients between January 1, 2001 and December 31, 2013. 

The 11 surgical procedures included were: total knee arthroplasty (TKA), total hip arthroplasty, laparoscopic cholecystectomy, open cholecystectomy, laparoscopic appendectomy, open appendectomy, cesarean delivery, functional endoscopic sinus surgery (FESS), cataract surgery, transurethral prostate resection (TURP), and simple mastectomy. A multivariable analysis was conducted to control for confounders such as sex, age, pre-op history of depression, psychosis, drug/alcohol use, and pre-op use of benzodiazepines, antipsychotics, and antidepressants.

The main outcome was chronic opioid use, defined as having filled ≥10 prescriptions or >120 days’ supply of an opioid in the first year after surgery, excluding the first 90 post-op days. For non-surgical patients, chronic opioid use was defined as having filled ≥10 prescriptions of >120 days’ supply after a randomized “surgery date.” 

A total of 641,941 opioid-naive surgery patients and 18,011,137 opioid-naive non-surgical patients were included in the study. Among surgical patients, the incidence of chronic opioid use in the first pre-op year ranged from 0.119% for Cesarean delivery (95% CI: 0.104–0.134) to 1.41% for TKA (95% CI: 1.29–1.53). Among non-surgical patients, the baseline use was 0.136% (95% CI: 0.134–0.137). 

Apart from cataract surgery, laparascopic appendectomy, FESS, and TURP, all of the surgeries were associated with a higher risk of chronic opioid use. Odds ratios ranged from 1.28 for Cesarean delivery (95% CI: 1.12–1.46) to 5.10 for TKA (95% CI: 4.67–5.58). 

Factors such as male gender, age >50 years, and pre-op history of drug/alcohol abuse, depression, benzodiazepine use, or antidepressant use were all associated with chronic opioid use among surgery patients. 

Dr. Sun and coauthors concluded that for opioid-naive patients, many procedures were associated with an increased risk of chronic opioid use, with a certain subgroup of patients at particularly greater risk. 

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