As opioid abuse approaches epidemic proportions, a new study shows how first-time exposure to opioids is standard practice after many common surgical procedures. Moreover, certain individuals were found to be especially vulnerable to future abuse.
As a result, researchers suggest opioid use should be closely monitored for up to a year after many surgeries.
Specifically, researchers discovered common surgical procedures were associated with increased risk for chronic opioid use in the first year after surgery by opioid-naïve patients — those who had not filled a prescription for the pain relievers in the year prior to surgery.
The new study appears online in JAMA Internal Medicine.
Experts note that 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, M.D., Ph.D., of Stanford University School of Medicine, California, and coauthors analyzed 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.
The authors’ study defined chronic opioid use 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 evaluated 11 surgical procedures: simple mastectomy, transurethral prostate resection (TURP), cataract, functional endoscopic sinus surgery (FESS), cesarean delivery, traditional (open) appendectomy, laparoscopic appendectomy, traditional (open) gallbladder removal, laparoscopic gall bladder removal, total hip replacement (THA), and total knee replacement (TKA).
Researchers discovered the increased chance of chronic opioid use in the first postoperative year ranged from 0.119 percent for cesarean delivery to 1.41 percent for TKA. For nonsurgical patients, the baseline incidence of chronic opioid use was 0.136 percent.
Except for cataract surgery, laparoscopic appendectomy, FESS, and TURP, all of the other surgical procedures were associated with increased risk of chronic opioid use.
Some of the highest risk was associated with total knee replacements, traditional gall bladder surgery, total hip replacements, and simple mastectomy.
Patient characteristics for an increased risk of opioid abuse included being male, older than 50, and having a preoperative history of drug abuse, alcohol abuse, depression, benzodiazepine use, or antidepressant use.
Researchers note that the study was observation and may have been influenced by unknown variables. The sample was also limited to privately insured patients ages 18 to 64, which may make the results not generalizable to other populations.
“Our results have several clinical implications. 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 percent for most of the procedures that we examined,” state the authors.
“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,” the study concludes.