Chronic Postoperative Opioid Use: A Systematic Review

Abstract

Background There are a number of studies in the literature that describe the prevalence, causes, and factors associated with chronic postoperative opioid use, but there is a lack of synthesis of the literature to guide clinicians in optimally managing postoperative pain while avoiding opioid dependence. Thus, the goal of this study was to perform a systematic review of the literature to investigate the prevalence of chronic postoperative opioid use and the associated risk factors. Materials and methods A systematic search was performed using Ovid Medline and Embase according to PRISMA guidelines. Data were collected on the following outcomes of interest: prevalence of opioid use at 3, 6, and 12 months postoperatively, and risk factors associated with chronic postoperative opioid use. Results Forty-three articles were included in the final analysis. The mean prevalence of chronic postoperative opioid use in all populations at 3, 6, and 12 months postoperatively was 30.5%, 25.6%, and 25.2%, respectively. The prevalence of patients who developed chronic opioid use at 3, 6, and 12 months postoperatively was 10.4%, 8.5%, and 9.8%, respectively. Forty of the articles analyzed risk factors associated with chronic postoperative opioid use. The most common associated risk factor identified was preoperative opioid use with 27 articles demonstrating a significant association with chronic postoperative opioid use. Discussion The current opioid crisis is in part secondary to the prevalence of chronic opioid use following surgery. This study identified associated risk factors with chronic postoperative opioid use, which may help identify patients at risk for developing chronic postoperative opioid use.

Chronic opioid use following surgery for head and neck cancer patients undergoing free flap reconstruction

“…Chronic postoperative opioid use is defined as continued opioid consumption greater than 3-months after surgery [13]. The causes of postoperative chronic opioid use are complex and multifactorial.…”

Opioid use prior to elective surgery is strongly associated with persistent use following surgery: an analysis of 14 354 Medicare patients

“…We were also able to compare multiple surgery types. A range of studies exist which have evaluated opioid use for TJR patients in isolation, but few have made comparisons across surgery types; we were unable to identify a study where pre‐surgery opioid users were analysed …”

“…A range of studies exist which have evaluated opioid use for TJR patients in isolation, but few have made comparisons across surgery types; we were unable to identify a study where pre-surgery opioid users were analysed. 23 Several limitations are worth noting. The use of an administrative data set limited the number of covariates we could include in the regression model and we are unable to adjust for unmeasured confounders.…”

Pre-operative opioid use in gynecologic oncology: a common comorbidity relevant to the peri-operative period

“…We have highlighted a concerning comorbidity of pre-operative opioid use in a gynecologic oncology surgical population in which 21% of patients were using pre-operative opioids. As a frequently occurring condition that affects post-operative outcomes, pre-operative opioid use warrants specific peri-operative planning and attention, especially as patients with pre-operative opioid use are more likely to develop chronic opioid use post-operatively 2 15. Even more concerning than the frequency of pre-operative opioid use is the lack of consistency in prescription patterns for these patients.…”