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Cited by 1,078Opioid Use Disorder TreatmentAnesthesia and Pain ManagementPain Management and Opioid Use

Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period

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Sun, Eric C., Darnall, Beth D., Baker, Laurence C., Mackey, Sean·2016·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2016.3298PMC PMC6684468
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Abstract

IMPORTANCE: Chronic opioid use imposes a substantial burden in terms of morbidity and economic costs. Whether opioid-naive patients undergoing surgery are at increased risk for chronic opioid use is unknown, as are the potential risk factors for chronic opioid use following surgery. OBJECTIVE: To characterize the risk of chronic opioid use among opioid-naive patients following 1 of 11 surgical procedures compared with nonsurgical patients. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of administrative health claims to determine the association between chronic opioid use and surgery among privately insured patients between January 1, 2001, and December 31, 2013. The data concluded 11 surgical procedures (total knee arthroplasty [TKA], total hip arthroplasty, laparoscopic cholecystectomy, open cholecystectomy, laparoscopic appendectomy, open appendectomy, cesarean delivery, functional endoscopic sinus surgery [FESS], cataract surgery, transurethral prostate resection [TURP], and simple mastectomy). Multivariable logistic regression analysis was performed to control for possible confounders, including sex, age, preoperative history of depression, psychosis, drug or alcohol abuse, and preoperatice use of benzodiazepines, antipsychotics, and antidepressants. EXPOSURES: One of the 11 study surgical procedures. MAIN OUTCOMES AND MEASURES: Chronic opioid use, defined as having filled 10 or more prescriptions or more than 120 days' supply of an opioid in the first year after surgery, excluding the first 90 postoperative days. For nonsurgical patients, chronic opioid use was defined as having filled 10 or more prescriptions or more than 120 days' supply following a randomly assigned "surgery date." RESULTS: The study included 641 941 opioid-naive surgical patients (169 666 men; mean [SD] age, 44.0 [12.8] years), and 18 011 137 opioid-naive nonsurgical patients (8 849 107 men; mean [SD] age, 42.4 [12.6] years). Among the surgical patients, the incidence of chronic opioid in the first preoperative year ranged from 0.119% for Cesarean delivery (95% CI, 0.104%-0.134%) to 1.41% for TKA (95% CI, 1.29%-1.53%) The baseline incidence of chronic opioid use among the nonsurgical patients was 0.136% (95% CI, 0.134%-0.137%). Except for cataract surgery, laparoscopic appendectomy, FESS, and TURP, all of the surgical procedures were associated with an increased risk of chronic opioid use, with odds ratios ranging from 1.28 (95% CI, 1.12-1.46) for cesarean delivery to 5.10 (95% CI, 4.67-5.58) for TKA. Male sex, age older than 50 years, and preoperative history of drug abuse, alcohol abuse, depression, benzodiazepine use, or antidepressant use were associated with chronic opioid use among surgical patients. CONCLUSIONS AND RELEVANCE: In opioid-naive patients, many surgical procedures are associated with an increased risk of chronic opioid use in the postoperative period. A certain subset of patients (eg, men, elderly patients) may be particularly vulnerable.

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  • Patients taking a selective serotonin reuptake inhibitor (SSRI) or a benzodiazepine prior to surgery to treat depression or anxiety have been identified as having the highest risk of persisting on opioids following major surgery.

    “Patients taking a selective serotonin reuptake inhibitor (SSRI) or a benzodiazepine prior to surgery to treat depression or anxiety have been identified as having the highest risk of persisting on opioids following major surgery.6,14”

    From Acceptance and Commitment Therapy to manage pain and opioid use after major surgery: Preliminary outcomes from the Toronto General Hospital Transitional Pain Service (2017) · cites this paper as [14]

    The Results report that preoperative benzodiazepine use (OR 1.82) and antidepressant use (OR 1.65) were associated with chronic opioid use after surgery. The Methods classify antidepressants as a group, not SSRIs specifically, and do not establish that the prescriptions were for depression or anxiety. The Results also show a higher odds ratio for a history of drug abuse (OR 3.15), so these medication users were not identified as having the highest risk. (LLM, conf=0.90)

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Authors
Sun, E. C., Darnall, B. D., Baker, L. C., & Mackey, S.
Affiliations
  • Stanford Medicine (US)
  • National Bureau of Economic Research (US)
Corresponding author
Sun, Eric C.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2016-09-01
Volume
176
Issue
9
Pages
1286
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2016.3298
PMC
PMC6684468
OpenAlex
W2460066114
Cited by
1,078
References
27
Citations by year
2026: 58 · 2025: 73 · 2024: 76 · 2023: 100 · 2022: 134 · 2021: 141 · 2020: 173 · 2019: 151 · 2018: 102 · 2017: 63 · 2016: 4 · 2015: 1 · 2014: 1
FWCI
105.78
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Anesthesia Quality Institute
  • National Center for Complementary and Integrative Health (P01AT006651, R01AT008561)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
  • Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords
chronic opioid use, opioid-naive patients, postoperative period, surgical procedures, risk factors, total knee arthroplasty, total hip arthroplasty, cholecystectomy, appendectomy, cesarean section, functional endoscopic sinus surgery, cataract surgery, transurethral resection of the prostate, mastectomy, opioid prescribing, opioid use disorder
MeSH terms
Adult, Age Factors, Analgesics, Opioid, Antidepressive Agents, Benzodiazepines, Depression, Female, Humans, Male, Opioid-Related Disorders, Postoperative Pain, Pain, Postoperative, Retrospective Studies, Risk Factors, Sex Factors, Surgical Procedures, Operative, United States, Incidence, Substance-Related Disorders

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