A new report published in JAMA Surgery found that new, persistent opioid use among surgical patients is more common than previously reported, and is one of the most common complications after elective surgery.
The investigators used nationwide insurance claims data from 2013 to 2014 to identify U.S. adults (aged 18 to 64 years) who did not use opioids in the year prior to surgery. For patients filling a perioperative opioid prescription, the researchers calculated the incidence of persistent opioid use for more than 90 days among patients who had not used opioids previously, after both minor and major surgical procedures, and assessed data for patient-level predictors of persistent opioid use.
Approximately 6% of post-surgical patients in the study used opioids for more than three months following surgery.
A total of 36,177 patients met the inclusion criteria: 29,068 (80%) had undergone minor surgical procedures and 7,109 (20%) had undergone major procedures. The rates of new persistent opioid use were similar between the two groups, ranging from 5.9% to 6.5%. By comparison, the incidence in the nonoperative control group was only 0.4%.
Risk factors independently associated with new persistent opioid use included preoperative tobacco use, alcohol and substance abuse disorders, mood disorders, anxiety, and preoperative pain disorders.
The authors concluded that new, persistent opioid use after surgery is common and is not significantly different between minor and major surgical procedures. Alternately, usage is associated with behavioral and pain disorders, suggesting that opioid use does not result from surgical pain but from addressable patient-level predictors. They also said that opioid use represents a common but underappreciated surgical complication, and it warrants increased awareness.