Photo Credit: Nuttiwut Rodbangpong

The following is a summary of “Persistent and chronic opioid use after ambulatory surgery in US Veterans (2011–2018),” published in the September 2024 issue of Surgery by Liu et al.

The extended use of opioids beyond the perioperative period is recognized as a potential adverse outcome, although it has primarily been studied in inpatients undergoing complex major surgeries. This study aimed to evaluate the risk of prolonged opioid use following ambulatory surgery and to identify the associated risk factors for long-term opioid prescriptions.

The cohort included 1,393,332 veterans who underwent ambulatory surgery within the Veterans Health Administration from October 1, 2011, to September 30, 2018 (Fiscal Year [FY] 12–18). Data were analyzed based on a range of patient factors, including age, sex, race, rural versus urban residence, body mass index, tobacco use, comorbidities as measured by the Charlson Comorbidity Index, psychiatric disorders, pre-surgery pain scores, substance use, and prior medication history, including the use of opioids, benzodiazepines, and antidepressants.

Results indicated that 9.6% of the cohort had at least one opioid prescription within 90–180 days post-surgery, classified as “persistent prescriptions,” and 1.8% had opioid prescriptions for more than 180 days within the 31–366 day period post-surgery, classified as “chronic prescriptions.” Encouragingly, the study found a significant decline in these rates over time, with persistent prescriptions decreasing from 12.5% in FY12 to 7.1% in FY18 and chronic prescriptions decreasing from 2.9% to 0.8% over the same period (P < .001 for both trends).

The strongest predictor for both persistent and chronic opioid prescriptions was prior opioid use, which was associated with a 2.8-fold increase in the risk of persistent use (adjusted odds ratio, 2.8; 95% CI, 2.8–2.9; P < .001) and a 3.3-fold increase in the risk of chronic opioid use (adjusted odds ratio, 3.3; 95% CI, 3.2–3.4; P < .001).

In conclusion, while the rates of prolonged opioid use following ambulatory surgery are relatively low and declining within the Veterans Health Administration, patients with prior opioid prescriptions remain at elevated risk. Providers should engage in informed discussions with patients about the risks of opioid use in postoperative pain management to mitigate these risks.

Source: sciencedirect.com/science/article/abs/pii/S0039606024005841