Risk factors of chronic opioid use after surgical procedures in noncancer patients: A nationwide case-control study

Abstract

Background: Surgery is an indication for opioid prescription in noncancer patients, and chronic use of opioids is associated with overdose and abuse.

Objectives: We aimed to evaluate the prevalence and risk factors associated with chronic opioid use (COU) following surgery among noncancer patients.

Design: A nationwide case-control study.

Setting: Retrospective analysis of the annual national patient sample data from 2012 to 2018 in South Korea.

Patients: Adults without cancer who had undergone surgery and received noninjectable opioids during hospital stay.

Main outcome measures: COU during 3 months following surgery.

Results: A total of 15 543 participants were included, and the prevalence overall and in opioid-naïve users was 8.1 and 5.7%, respectively. Prior exposure patterns of opioids [intermittent user, adjusted odds ratio (aOR) 2.35; 95% CI, 2.00 to 2.77, and continuous user, aOR 8.58; 95% CI, 6.54 to 11.24] and concomitant use of benzodiazepine (in continuous user, aOR 18.60; 95% CI 11.70 to 29.55) were strongly associated with COU compared with naïve users. Morphine milligram equivalent, type of opioid strength at discharge and prescription of nonopioid analgesics at discharge were also associated with COU. Compared with minor surgery, knee (aOR 1.49; 95% CI 1.17 to 1.89), spine (aOR 1.65; 95% CI 1.33 to 2.06) and shoulder (aOR 2.54; 95% CI 1.97 to 3.27) procedures showed a significantly positive association with COU. Sensitivity analysis in opioid-naïve patients showed similar results.

Conclusion: About 8.1% of noncancer patients who had undergone surgery and were prescribed noninjectable opioids became chronic opioid users in Korea. Identified risk factors could be used to derive strategies for safe opioid use in noncancer patients in the future.