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Cited by 2,025Opioid Use Disorder TreatmentAnesthesia and Pain ManagementPain Management and Opioid Use

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

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Brummett, Chad M., Waljee, Jennifer F., Goesling, Jenna, Moser, Stephanie, Lin, Paul, Englesbe, Michael J., Bohnert, Amy S. B., Kheterpal, Sachin +1 more·2017·JAMA Surgery
DOI 10.1001/jamasurg.2017.0504PMC PMC7050825
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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.

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  • Many risk factors for chronic postsurgical pain are also associated with persistent opioid use after surgery, including mood disorders, anxiety, pain catastrophizing, preoperative neuropathic and nonneuropathic pain, and greater pain intensity on the day of surgery.

    “Notably, many of the above risk factors for CPSP are also associated with persistent opioid use after surgery, including mood disorders,57 anxiety,57 pain catastrophizing,58 preoperative neuropathic and nonneuropathic pain,57 and greater pain intensity on the day of surgery.58”

    From Chronic postsurgical pain: From risk factor identification to multidisciplinary management at the Toronto General Hospital Transitional Pain Service (2019) · cites this paper as [57]

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  1. [3]Russo A, Elixhauser A, Steiner C, Wier L. Hospital-Based Ambulatory Surgery, 2007: Statistical Brief #86. 2006. 21452492

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Authors
Brummett, C. M., Waljee, J. F., Goesling, J., Moser, S., Lin, P., Englesbe, M. J., Bohnert, A. S. B., Kheterpal, S., & Nallamothu, B. K.
Affiliations
University of Michigan (US)
Corresponding author
Brummett, Chad M.
ORCID
Venue
JAMA Surgery
Publisher
American Medical Association (AMA)
Published
2017-06-21
Volume
152
Issue
6
Pages
e170504
ISSN
2168-6254 (ISSN-L)
DOI
10.1001/jamasurg.2017.0504
PMC
PMC7050825
OpenAlex
W2607168684
Cited by
2,025
References
39
Citations by year
2026: 138 · 2025: 165 · 2024: 173 · 2023: 188 · 2022: 272 · 2021: 295 · 2020: 304 · 2019: 269 · 2018: 171 · 2017: 38
FWCI
200.82
Type
journal article
Language
en
Open access
Locations
  • JAMA Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Agency for Healthcare Research and Quality (K08HS023313)
  • National Institute on Drug Abuse (R01DA038261, R01DA042859)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR060392)
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
persistent opioid use, postoperative opioid prescribing, minor surgery, major surgery, opioid-naive patients, risk factors, tobacco use, mood disorders, postoperative pain
MeSH terms
Adult, Analgesics, Opioid, Cross-Sectional Studies, Female, Humans, Long-Term Care, Male, Middle Aged, Pain, Postoperative, Postoperative Pain, Risk Factors, Minor Surgical Procedures, Surgical Procedures, Operative, United States, Incidence, Prescription Drug Misuse

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