Risk of Chronic Opioid Use Rises Among Opioid-Naïve Patients After Surgery

An analysis of health claims shows that the risk of chronic opioid use rises among patients who never used opioids prior to surgery following 11 common surgical procedures, a new study reveals. The study found a slight overall increase in risk of 0.5%, but some surgeries were associated with a higher risk of getting addicted to painkillers than other procedures.

Patients who had knee surgery had the largest risk (approximately 5 times more likely than a control group of nonsurgical patients to use opioids chronically), followed by those undergoing gallbladder surgery, for whom the risk was 3.5 times greater than those in the control group.

Lead author Eric C. Sun, MD, PhD, an instructor in anesthesiology at Stanford University School of Medicine, and colleagues retrospectively reviewed administrative health claims between January 2001 and December 2013 among privately insured patients to determine the association between chronic opioid use and 11 common types of surgery: 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.

The study, published in JAMA Internal Medicine, defined chronic opioid use as having filled 10 or more prescriptions or more than 120 days’ supply of an opioid in the first year after surgery (excluding the first 90 days). The study included 641,941 opioid-naïve surgical patients and 18,011,137 opioid-naïve nonsurgical patients.

Among the surgical patients, the incidence of chronic opioid use in the first preoperative year ranged from 0.119% for Cesarean delivery to 1.41% for TKA. The baseline incidence of chronic opioid use among the nonsurgical patients was 0.136%. With the exception of cataract surgery, laparoscopic appendectomy, FESS, and TURP, all of the surgical procedures were associated with an increased risk of chronic opioid use, with odds ratios ranging from 1.28 for Cesarean delivery to 5.10 for TKA.

Male sex, age over 50 years, and preoperative history of drug abuse, alcohol abuse, depression, benzodiazepine use, or antidepressant use were associated with chronic opioid use among surgical patients.

“The message isn’t that you shouldn’t have surgery,” Sun said in a statement. “Rather, there are things that anesthesiologists can do to reduce the risk by finding other ways of controlling the pain and using replacements for opioids when possible.”

He suggested the use of regional anesthetics when possible to reduce the need for opioids post-surgery, and he added that patients should be encouraged to use pain-management alternatives such as Tylenol after surgery.