New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults

Abstract

Importance: Despite increased focus on reducing opioid prescribing for long-term pain, little is known regarding the incidence and risk factors for persistent opioid use after surgery.

Objective: To determine the incidence of new persistent opioid use after minor and major surgical procedures.

Design, setting, and participants: Using a nationwide insurance claims data set from 2013 to 2014, we identified US adults aged 18 to 64 years without opioid use in the year prior to surgery (ie, no opioid prescription fulfillments from 12 months to 1 month prior to the procedure). For patients filling a perioperative opioid prescription, we calculated the incidence of persistent opioid use for more than 90 days among opioid-naive patients after both minor surgical procedures (ie, varicose vein removal, laparoscopic cholecystectomy, laparoscopic appendectomy, hemorrhoidectomy, thyroidectomy, transurethral prostate surgery, parathyroidectomy, and carpal tunnel) and major surgical procedures (ie, ventral incisional hernia repair, colectomy, reflux surgery, bariatric surgery, and hysterectomy). We then assessed data for patient-level predictors of persistent opioid use.

Main outcomes and measures: The primary outcome was defined a priori prior to data extraction. The primary outcome was new persistent opioid use, which was defined as an opioid prescription fulfillment between 90 and 180 days after the surgical procedure.

Results: A total of 36 177 patients met the inclusion criteria, with 29 068 (80.3%) receiving minor surgical procedures and 7109 (19.7%) receiving major procedures. The cohort had a mean (SD) age of 44.6 (11.9) years and was predominately female (23 913 [66.1%]) and white (26 091 [72.1%]). The rates of new persistent opioid use were similar between the 2 groups, ranging from 5.9% to 6.5%. By comparison, the incidence in the nonoperative control cohort was only 0.4%. Risk factors independently associated with new persistent opioid use included preoperative tobacco use (adjusted odds ratio [aOR], 1.35; 95% CI, 1.21-1.49), alcohol and substance abuse disorders (aOR, 1.34; 95% CI, 1.05-1.72), mood disorders (aOR, 1.15; 95% CI, 1.01-1.30), anxiety (aOR, 1.25; 95% CI, 1.10-1.42), and preoperative pain disorders (back pain: aOR, 1.57; 95% CI, 1.42-1.75; neck pain: aOR, 1.22; 95% CI, 1.07-1.39; arthritis: aOR, 1.56; 95% CI, 1.40-1.73; and centralized pain: aOR, 1.39; 95% CI, 1.26-1.54).

Conclusions and relevance: New persistent opioid use after surgery is common and is not significantly different between minor and major surgical procedures but rather associated with behavioral and pain disorders. This suggests its use is not due to surgical pain but addressable patient-level predictors. New persistent opioid use represents a common but previously underappreciated surgical complication that warrants increased awareness.

Figure 1:. Sample criteria and outcomes.

Patients undergoing the predefined surgeries were included if they met the following criteria: 1) continuous insurance coverage during the 12 months prior to surgery through the 6 months after surgery; 2) no opioid prescriptions during the 11 months prior to surgery; 3) at least on opioid prescription fill during the perioperative period, which was defined as the 30 days prior to surgery to 2 weeks after discharge. The outcome of new persistent opioid use was defined as at least one opioid prescription fill between 90–180 days after surgery.

Figure 2:

Flow diagram.

Figure 3:. Incidence of new persistent opioid use by surgical condition.

The incidence of new persistent opioid use was similar between the two groups (minor surgery= 5.9% vs. major surgery = 6.5%; OR 1.12, SE 0.06, 95% CI 1.01–1.24). By comparison, the incidence in the nonoperative control group was only 0.4%.