Prolonged Opioid Use After Surgery May Burden Public Health

Results of a systematic review and meta-analysis demonstrate the potential importance of evaluating opioid use among patients before surgery to modify patient-level risk factors.

The findings, from Oluwadolapo Lawal, MPH, and a team of investigators, suggested prolonged opioid use after surgery may be a substantial burden to public health. Strategies like proactively screening at-risk individuals should be prioritized.

Lawal and colleagues evaluated the rate and characteristics of patient-level risk factors associated with increased risk of prolonged use of opioids after surgery. The team identified relevant studies through an initial literature search of MEDLINE, Embase, and Google Scholar from the inception of the databases to August 30, 2017. They selected eligible studies from electronic databases using search terms and keywords such as opioid analgesics, general surgery, surgical procedures, persistent opioid use, and postoperative pain.

Studies were eligible if they were observational and evaluated opioid use after surgery. The investigators included studies that were: published in the English language, enrolled participants at least 18 years old, included a minimum of 50 patients, involved a noninjectable opioid prescription fill at least 3 months after the index surgical procedure, and reported the rate and adjusted outcome estimates for patient-level risk factors associated with prolonged opioid use after surgery.

Investigators extracted the study design, sample size, length of follow-up, types of surgical procedure, proportions of opioid-naïve and opioid-experienced individuals at baseline, and the definitions of prolonged opioid use after surgery. They also collected rates and adjusted estimates associated with the longest follow-up time.

The primary measure was the pooled rate and magnitude for individual risk factors of prolonged opioid use after surgery.

Overall, the team included 33 studies with 1,922,743 individuals. A majority of the studies (96.4%) were from the US. Of the studies with available sex and age data, participants were mostly female (82.7%) and had a mean age of 59.3 years.

The rate of prolonged opioid use after surgery was 6.7% (95% CI, 4.5-9.8) but decreased to 1.2% (95% CI, .4-3.9) in restricted analyses involving only opioid-naive participants at the start of the study. Risk factors with the strongest associations with prolonged opioid use were preoperative use of opioids (OR, 5.32; 95% CI, 2.94-9.64) or illicit cocaine (OR, 4.34; 95% CI, 1.50-12.58) and a preoperative diagnosis of back pain (OR, 2.05; 95% CI, 1.63-2.58). There were no significant differences with various study-level factors including a comparison of major versus minor surgical procedures (pooled rate: 7%; 95% CI, 4.9-9.9 vs 11.1%; 95% CI, 6-19.4; P=.2).

The team’s analyses indicated approximately 7% of patients filled opioid prescriptions at 3 months and more than 1 year after surgery, which is beyond the normal postoperative recovery period. There was a higher rate observed when prolonged opioid use was defined as the filling of at least 1 prescription for opioids within 91-180 days after surgery.

To reduce burden related to prolonged opioid use, providers should characterize the underlying mechanisms that may be associated with prolonged and/or chronic use of opioids after surgery, the investigators suggested. Additional research is needed to further investigate the association.

The study, “Rate and Risk Factors Associated With Prolonged Opioid Use After Surgery,” was published online in JAMA Network Open.