Opioid use after minor surgery significantly increased the likelihood of opioid use a year later among older, opioid-naive patients, Canadian investigators reported.

Patients who received opioids within seven days of surgery were 44% more likely to be using opioids a year later. Use of non-steroidal anti-inflammatory drugs (NSAIDs) after minor surgery was associated with a nearly fourfold increase in use a year later.

“As rates of ambulatory surgery among elderly populations increase, preventing analgesic therapy initiation could have far-reaching implications for those involved in the perioperative care of this population,” Chaim M. Bell, MD, PhD, of St. Michael’s Hospital in Toronto, and co-authors wrote in conclusion in the March 12 issue of Archives of Internal Medicine.

“Concerted patient safety efforts must continue to focus on providing an opportunity for patients to heal from operations free of short-term pain while minimizing the risks of long-term adverse effects.”

Most instances of postoperative analgesic use has a goal of short-term pain relief. However, short-term use may evolve into long-term administration, placing patients at increased risk of drug-related adverse effects, the authors wrote in their introduction.

To determine the frequency of long-term analgesic use after minor surgery, Bell and colleagues examined medical records of Ontario residents 66 and older who underwent short-stay surgery from 1997 to 2008.

Procedures included in the study were cataract surgery, laparoscopic cholecystectomy, transurethral resection of the prostate, and varicose vein stripping.

Investigators limited the search to patients who had no prior opioid use, and they identified all patients who received new prescriptions for opioids within seven days of surgery.

The primary objective of the study was to examine the relationship between early postsurgical use of opioid analgesics and long-term use.

The final analysis included 391,139 patients, 27,636 (7.1%) who received opioids within seven days. A year after surgery, 30,145 (7.7%) had prescriptions for opioids. In particular, oxycodone use increased from 5.4% of patients in the seven days after surgery to 15.9% at one year.

The data showed that 2,857 (10.3%) of patients who received opioids within seven days were still using opioids a year later. Logistic regression analysis showed that early opioid use was associated with an odds ratio of 1.44 for opioid use at one year, as compared with patients who did not begin opioids within the first seven days.

A secondary analysis focused on the relationship between early and long-term use of NSAIDs.

Of 383,780 patients who were NSAID-naive at the time of surgery, 1,169 (0.3%) had an NSAID prescription within seven days of surgery. A year later, 30,080 (7.8%) patients had NSAID prescriptions, including 285 (24.4%) of the patients who started NSAIDs soon after surgery.

NSAID use within seven days of surgery was associated with an odds ratio of 3.74 for prescription NSAID use at one year.

“Although the use of these medications is likely justified for operations in which postoperative pain is a major concern, little is known about patterns of analgesic use in operations in which postoperative pain is usually not a significant consideration,” the authors wrote in their discussion.

“This may be particularly worrisome when patients are prescribed standardized doses of analgesics to take at their discretion, regardless of the anticipated severity of postoperative pain.”

The article serves as a reminder that the benefits of any drug should justify the potential risks, according to the author of an editor’s note.

“In the case of this study, it is unclear why 7% of elderly persons who were not previously taking opioids should have required them for minor operations known to cause little pain or why 8% of those who received an opioid for acute pain associated with minor surgery were still taking opioids one year later,” wrote Mitchell H. Katz, MD.

“We believe when it comes to an opioid administration for minor surgery, among older persons, less is more.”

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Primary source: Archives of Internal Medicine
Source reference: Alam A, et al “Long-term analgesic use after low-risk surgery. A retrospective cohort study” Arch Intern Med 2012; 172: 425-430; DOI: 10.1001/archinternmed.2011.1827.