Certain common surgical procedures, including total knee and hip replacements, were associated with an increased risk for chronic opioid use in the first year after surgery, according to a new study published in JAMA Internal Medicine.
Researchers examined administrative health claims data for privately insured patients. The analyzed claims for 641,941 opioid-naïve surgical patients and more than 18 million opioid-naïve nonsurgical patients.
The study defined chronic opioid use as having filled 10 or more prescriptions, or more than 120 days' supply, within the first year after surgery, excluding the first 90 days after surgery.
The study examined the following surgical procedures:
• Simple mastectomy
• Transurethral prostate resection
• Cataract surgery
• Functional endoscopic sinus surgery
• Cesarean delivery
• Open appendectomy
• Laparoscopic appendectomy
• Open cholecystectomy
• Laparoscopic cholecystectomy
• Total hip arthroplasty
• Total knee arthroplasty
Here are four insights:
1. The incidence of chronic opioid use in the first year post surgery was highest among TKA patients (1.41 percent) and lowest among for cesarean delivery (0.119 percent).
2. With the exception of cataract surgery, laparoscopic appendectomy, FESS and TURP, all of the other surgical procedures were associated with increased risk of chronic opioid use.
3. TKA, open cholecystectomy, THA and simple mastectomy were associated with some of the highest risk of chronic opioid use.
4. The baseline incidence of chronic opioid use among nonsurgical patients was 0.136 percent.
"Our results have several clinical implications. First, while we found that surgical patients are at an increased risk for chronic opioid use, the overall risk for chronic opioid use remains low among these patients, at less than 0.5 percent for most of the procedures that we examined. Thus, our results should not be taken as advocating that patients forgo surgery out of concerns for chronic opioid use. Rather, our results suggest that primary care clinicians and surgeons should monitor opioid use closely in the postsurgical period," study authors concluded, according to a statement.