Don't Blame Surgery for Most Opioid Abuse

Surgery patients in general show only a slightly elevated risk of becoming addicted to opioids compared to that of the population as a whole, a new study of privately insured patients showed.

“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 we examined,” said Eric Sun, MD, PhD, of Stanford University School of Medicine in Stanford, CA.

The only exceptions were patients who got certain surgeries including total knee replacement, where 1.41 percent of patients developed opioid dependence, Sun found.

Though the risk is small, Sun and colleagues advised physicians to track their surgical patients' opioid use carefully.

Reporting in JAMA Internal Medicine, Sun and colleagues looked at administrative health claims data for millions of patients who had 11 common surgical procedures. Those were simple mastectomy, transurethral prostate resection, cataract removal, functional endoscopic sinus surgery, cesarean delivery, open appendectomy, laparoscopic appendectomy, open gall bladder removal, laparoscopic gall bladder removal, total hip replacement, and total knee replacement.

The team’s goal was to see how common chronic opioid use in the first year after surgery among patients who had not used opioids in the year prior to getting an operation.

They tallied opioid prescriptions for 641,941 surgical patients and compared their numbers of prescriptions for the drugs to 18 million non-surgical patients who also had not filled opioid prescriptions in the year prior. The researchers defined chronic opioid use as having filled more than 10 prescriptions or obtained a 120 days’ supply within the first year after surgery, excluding the first 90 postoperative days.

Overall, the control group’s rate of becoming chronic opioid users was 0.136 percent. That rate was actually higher than some surgery patients, namely women who had had cesarean deliveries whose rate of chronic opioid use post-surgery was 0.119 percent.

Among the 11 common surgical procedures evaluated in the study, total knee replacement carried the highest risk of post-surgical opioid use, with a chronic-use rate of 1.41 percent.

Male patients and those with a history of substance abuse were most likely to become chronic users, Sun found.

Because the study was based on patients with private insurance the results may not hold true for patients who are uninsured or government-insured.

Still, “Our results should not be taken as advocating that patients forgo surgery out of concerns for chronic opioid use,” the team wrote, “Rather, our results suggest that primary care clinicians and surgeons should monitor opioid use closely in the postsurgical period.”