Toronto, Ontario—How likely is it that patients with little or no opioid use in the past will develop persistent use of painkillers after surgery?

Not very, according to a research letter recently published online by JAMA Surgery.

To determine that, Canadian researchers from Toronto Western Hospital and colleagues tracked rates of ongoing opioid use up to 1 year after major surgery.

Background information in the article notes that exposure to opioids is largely unavoidable after major surgery because of their use to treat postoperative pain. Despite concerns about continued long-term opioid use, however, little data exists on the risk of previously opioid-naive individuals developing persistent postoperative opioid use, according to study authors.

To remedy that, the researchers conducted an analysis of anonymized administrative population-based healthcare data capturing information on outpatient prescriptions dispensed to Ontario residents aged 65 years or older. The study group included individuals who were aged 66 years or older; were opioid naïve in the prior year; and underwent major elective surgeries, including coronary artery bypass graft surgery via sternotomy, open and minimally invasive lung resection surgery, open and minimally invasive colon resection surgery, open and minimally invasive radical prostatectomy, and open and minimally invasive hysterectomy from 2003 to 2010.

The time to opioid cessation for any individual receiving an opioid prescription within 90 days after surgery was measured, with the date of cessation defined by the absence of any opioid prescription within the preceding 90 days.

Participants included 39,140 opioid-naive patients, of whom 53% received one or more opioid prescriptions within 90 days after discharge. A year after surgery, only 168 of 37,650 surviving patients (0.4%) continued to receive ongoing opioid prescriptions.
Lung resection procedures led to the highest risk of long-term persistent opioid use, according to the results.

The study “provides reassurance that the individual risk of long-term opioid use in opioid-naive surgical patients is low,” the authors conclude. “Conversely, the large volume of surgeries performed annually means that the population burden of long-term postoperative opioid use remains significant.”

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