Rates and risk factors for prolonged opioid use after major surgery: population based cohort study
By H. Clarke, N. Soneji, Dennis T. Ko, L. Yun, D. Wijeysundera. British medical journal, 2014
889 citations recorded by the source corpus.
Objective To describe rates and risk factors for prolonged postoperative use of opioids in patients who had not previously used opioids and undergoing major elective surgery. Design Population based retrospective cohort study. Setting Acute care hospitals in Ontario, Canada, between 1 April 2003 and 31 March 2010. Participants 39 140 opioid naïve patients aged 66 years or older who had major elective surgery, including cardiac, intrathoracic, intra-abdominal, and pelvic procedures. Main outcome measure Prolonged opioid use after discharge, as defined by ongoing outpatient prescriptions for opioids for more than 90 days after surgery. Results Of the 39 140 patients in the entire cohort, 49.2% (n=19 256) were discharged from hospital with an opioid prescription, and 3.1% (n=1229) continued to receive opioids for more than 90 days after surgery. Following risk adjustment with multivariable logistic regression modelling, patient related factors associated with significantly higher risks of prolonged opioid use included younger age, lower household income, specific comorbidities (diabetes, heart failure, pulmonary disease), and use of specific drugs preoperatively (benzodiazepines, selective serotonin reuptake inhibitors, angiotensin converting enzyme inhibitors). The type of surgical procedure was also highly associated with prolonged opioid use. Compared with open radical prostatectomies, both open and minimally invasive thoracic procedures were associated with significantly higher risks (odds ratio 2.58, 95% confidence interval 2.03 to 3.28 and 1.95 1.36 to 2.78, respectively). Conversely, open and minimally invasive major gynaecological procedures were associated with significantly lower risks (0.73, 0.55 to 0.98 and 0.45, 0.33 to 0.62, respectively). Conclusions Approximately 3% of previously opioid naïve patients continued to use opioids for more than 90 days after major elective surgery. Specific patient and surgical characteristics were associated with the development of prolonged postoperative use of opioids. Our findings can help better inform understanding about the long term risks of opioid treatment for acute postoperative pain and define patient subgroups that warrant interventions to prevent progression to prolonged postoperative opioid use.
Subfields: Anesthesiology and Pain Medicine, Public Health, Environmental and Occupational Health, Surgery
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Citations in the corpus
- Consensus statement for perioperative care in total hip replacement and total knee replacement surgery: Enhanced Recovery After Surgery (ERAS®) Society recommendations (2019, background): “In addition, prolonged opioid use in and after surgery is a leading risk factor for longer term addiction and so should be avoided (Clarke et al. 2014).”
- New Persistent Opioid Use After Minor and Major Surgery in U.S. Adults (2017, methodology): “Outcomes Our primary outcomewas newpersistent opioid use, defined as anopioidprescription fulfillment between90and 180days among those patients who filled opioid prescriptions perioperatively (Figure 1) and was defined a priori prior to data extraction.(8) This definition of new persistent opioid us”