Ongoing Use of Analgesics after Low-Risk Surgery

Opioid analgesics are sometimes initiated after common low-risk surgeries. In this study, researchers used a large administrative Canadian health database to identify opioid-naïve adults 66 years and older who received an opioid prescription within 7 days of a low-risk surgery (transurethral resection of the prostate, varicose vein stripping, cataract surgery, or laparoscopic cholecystectomy). Long-term use was assessed by prescription for opioids within 60 days of the 1-year anniversary of the surgery. A similar analysis was conducted for nonsteroidal anti-inflammatory drugs (NSAIDs).

• Seven percent of opioid-naïve patients (26,636 of 391,139) received an opioid prescription within 7 days of low-risk surgery. Opioid use ranged from 5% after cataract surgery to 65% after laparoscopic cholecystectomy. Codeine was the most commonly prescribed opioid.

• Ten percent of patients who received opioids after surgery (2857 of 26,636) continued to use opioids 1 year later.

• In adjusted analyses, patients who received opioids after surgery were 44% more likely to be using opioids 1 year later.

• Only 0.3% of NSAID-naïve patients received an NSAID prescription within 7 days of surgery; however, in adjusted analyses, these patients were 4 times more likely to have an NSAID prescription 1 year after surgery.

Comments:

This study shows that patients who received opioids or NSAIDs after low-risk surgery are more likely to still be using these drugs 1 year later. Clinicians should be cautious to prescribe opioids only when indicated after low-risk surgery and to carefully assess the need for continued use.

Kevin L. Kraemer, MD, MSc

Reference:

Alam A, Gomes T, Zheng H, et al. Long-term analgesic use after low-risk surgery. Arch Intern Med. 2012;172(5):425–430.