Drugs Xagena
The objective of a study was to describe rates and risk factors for prolonged postoperative use of opioids in patients who had not previously used opioids and undergoing major elective surgery.
The population-based retrospective cohort trial was performed in Ontario, Canada, during the period 2003-2010, and enrolled
39 140 opioid naïve patients, aged 66 years or older, who had major elective surgery, including cardiac, intrathoracic, intra-abdominal, and pelvic procedures.
The main outcome measure was prolonged opioid use after discharge, as defined by ongoing outpatient prescriptions for opioids for more than 90 days after surgery.
Of the 39 140 patients in the entire cohort, 49.2% ( n=19 256 ) were discharged from hospital with an opioid prescription, and 3.1% ( n=1229 ) continued to receive opioids for more than 90 days after surgery.
Following risk adjustment with multivariable logistic regression modelling, patient related factors associated with significantly higher risks of prolonged opioid use included younger age, lower household income, specific comorbidities ( diabetes mellitus, heart failure, pulmonary disease ), and use of specific drugs preoperatively ( benzodiazepines, selective serotonin reuptake inhibitors, angiotensin converting enzyme inhibitors ).
The type of surgical procedure was also highly associated with prolonged opioid use. Compared with open radical prostatectomies, both open and minimally invasive thoracic procedures were associated with significantly higher risks ( odds ratio, OR=2.58, 95% confidence interval 2.03 to 3.28 and 1.95 1.36 to 2.78, respectively ).
Conversely, open and minimally invasive major gynaecological procedures were associated with significantly lower risks ( 0.73, 0.55 to 0.98 and 0.45, 0.33 to 0.62, respectively ).
In conclusion, approximately 3% of previously opioid naïve patients continued to use opioids for more than 90 days after major elective surgery.
Specific patient and surgical characteristics were associated with the development of prolonged postoperative use of opioids.
The findings can help better inform understanding about the long term risks of opioid treatment for acute postoperative pain and define patient subgroups that warrant interventions to prevent progression to prolonged postoperative opioid use. ( Xagena )
Clarke H et al, BMJ 2014;348:g1251
XagenaMedicine_2014
