Major elective surgery usually doesn't lead to long-term opioid use

About 3% of previously opioid-naive patients continued to use opioids for more than 90 days after major elective surgery, a study found.

Researchers conducted a retrospective cohort study in acute care hospitals in Ontario, Canada. Using several linked population-based administrative databases, they included 39,140 opioid-naive patients age 66 years or older who had 1 of 9 major elective surgeries from April 2003 to March 2010. Surgeries included cardiac, intrathoracic, intra-abdominal, and pelvic procedures.

Results appeared online Feb. 11 at BMJ.

Of the studied patients, 49.2% (n=19,256) were discharged from the hospital with an opioid prescription, and 3.1% (n=1,229) continued to receive opioids for more than 90 days after surgery.

The type of surgical procedure was highly associated with prolonged opioid use. Thoracic procedures had the highest risks (odds ratio [OR], 2.58 [95% CI, 2.03 to 3.28] for open thoracic procedures compared to open radical prostatectomies and 1.95 [95% CI, 1.36 to 2.78] for minimally invasive thoracic procedures). Major gynecological procedures were associated with even lower risks than radical prostatectomies (OR, 0.73 [95% CI, 0.55 to 0.98] for open gynecological procedures and 0.45 [95% CI, 0.33 to 0.62] for minimally invasive gynecological procedures).

Patient-related factors associated with significantly higher risks of prolonged opioid use included younger age; lower household income; specific comorbidities such as diabetes, heart failure and pulmonary disease; and use of certain drugs preoperatively, such as benzodiazepines, selective serotonin reuptake inhibitors and angiotensin-converting enzyme inhibitors.

The researchers noted that the figure of 3.1% represents a large absolute number of patients who continue to use opioids for more than 3 months after surgery, and a substantial overall public health concern at the population level.

Still, researchers wrote, “Patients can therefore be reassured that when people receive opioids appropriately to treat acute pain after major surgery, the majority do not experience prolonged use. Our findings therefore help inform patients' and clinicians' understanding of the risks of prolonged opioid use after major surgery, especially since patients' understandable fears about opioid dependence may be an important barrier to achieving adequate acute postsurgical pain relief.”