Lung Surgery Leads to New Opioid Dependencies

Alexander A. Brescia

Lung operation is driving opioid dependence in recovering patients.

Analysis presented at the 54^th Annual Meeting of the Society of Thoracic Surgeons this week found that approximately 1 in 7 (14%) lung resection surgery patients become new persistent opioid users in the months following their procedure.

The distinction is reserved for patients who had no opioid therapy regimen or use prior to surgery, but began and continued opioid treatment well after physical recovery was complete. The study, led by Alexander A. Brescia, MD, of the University of Michigan, has great implications for the field: surgeons are the main prescribers of opioid medication following procedures.

Using the insurance claims of cancer patients from the Truven Health MarketScan database between Janaury 2010 and June 2014, researchers were able to access a database of 100-plus US health plans and find 3,026 lung resection patients. They found that the rate of new persistent opioid use was even more prevalent in the patients who had a traditional lung operation in that time span.

The patients who underwent open resection with a large incision were nearly twice as likely to develop new persistent opioid use (17%) than those who underwent minimally invasive operations such as video-assisted thoracoscopic surgery (9%).

Brescia said in a statement that the research exposes a need to examine specific opioid use risk factors. Male sex, ages less than 64 years, a history of substance abuse, and post-operative hospital stay lasting more than 5 days were all indicated as independent risk factors.

“Our research attaches data to this epidemic and hopefully provides a clear characterization of the issue and highlights ways to combat the crisis, with important roles for both surgeons and patients,” Brescia said.

The correlation between thoracic surgery and postoperative chronic opioid use has been observed previously in international health systems dealing with opioid-naïve patients, David T. Cooke, MD, Head of General Thoracic Surgery at the University of California Davis, said.

“The research highlights unintended contributions of thoracic surgery to the opioid epidemic and provides an opportunity for thoracic surgeons to be leaders and change makers in ending the national opioid crisis,” Cooke said.

Though the US Centers for Disease Control and Prevention (CDC) reported that US opioid prescriptions have been annually decreasing since peaking at more than 255 million in 2012, the number is still massive. More than 214 million opioid prescriptions were provided in 2016.

The study calls not just for a consideration into individual risks, but strategies between physicians and patients to limit their toll on the opioid epidemic.

“Taking opioids for pain following an operation could put patients at risk of becoming dependent or addicted to these medications,” Brescia said. “Together with their surgeons, patients should develop a plan to appropriately manage their pain while also minimizing their risk of taking these medications for longer than intended after surgery.”

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