A new risk has been discovered for patients who have surgery – chronic opioid use later on. A new study found that patients who had surgery and who had not previously used opioids were more likely to begin chronic use of the medication than patients who did not have surgery.
The study, from Stanford University Medical Center, looked at 11 surgical procedures: total hip arthroplasty, total knee arthroplasty, open cholecystectomy, laparoscopic cholecystectomy, open appendectomy, cesarean delivery, cataract surgery, functional endoscopic sinus surgery, transurethral prostate resection and simple mastectomy.
Researchers analyzed data from health claims from the period of Jan. 1, 2001 through Dec. 31, 2013, comparing 641,941 “opioid-naive” surgical patients with a mean age of 44 with 18,011,137 opioid-naive nonsurgical patients with a mean age of 42.4. The patients were considered opioid-naive if they had not had an opioid prescription filled in the previous year.
The findings of the study showed that the incidence of chronic opioid use in the first post-operative year was significantly higher than for nonsurgical patients. Chronic opioid use was defined as having 10 or more prescriptions, or more than a 120-day supply, of an opioid medication in the first year after surgery, not counting the first 90 post-operative days.
The seven procedures associated with the greatest increase in chronic opioid use were total knee arthroplasty, open cholecystectomy, total hip arthroplasty, simple mastectomy, laparoscopic cholecystectomy, open appendectomy and cesarean delivery.
There were other characteristics associated with the increased risk of post-operative opioid abuse, including male sex, age over 50 years, preoperative use of benzodiazepines, preoperative use of antidepressants, depression history, alcohol abuse history and drug abuse history.
Researcher Eric Sun, MD, PhD, said surgery “may unmask an individual’s susceptibility toward long-term opioid use.” Patients with higher risk characteristics may benefit from techniques to reduce the need for the drugs. However, the study notes that the results should not be taken as advice that patients forgo surgery out of concern for developing problems with opioid abuse, but rather that they should be carefully monitored in the post-surgical period.
The researchers acknowledge that their were limits to the design of their study. Socioeconomic status was not measured, and data was only from privately insured patients. Although previous studies have found an increased risk in opioid use after surgery, this was the first to look at patients who went into surgery opioid-naive.
The study was published online in JAMA Internal Medicine on July 11.