Preoperative factors predict persistent opioid use after surgery

For many Americans, a surgical experience can unexpectedly lead to long-term opioid use. While most patients discontinue opioid pain medication after recovery, a significant number of individuals, previously not using these drugs, may develop New Persistent Opioid Use (NPOU) – continuing use well beyond the expected healing period.

Identifying Risk Factors for Long-Term Opioid Use

Researchers at Penn Nursing have conducted a comprehensive study, published in Pain Medicine, to pinpoint the specific factors that increase a patient’s risk of transitioning to long-term opioid use following surgery. The study analyzed data from 27 high-quality studies and identified four key predictors of NPOU: Medicaid enrollment, preoperative benzodiazepine use, mood disorders and anxiety.

Did You Know? NPOU is defined as continued opioid use beyond three months after surgery and has been linked to increased morbidity, higher mortality rates, and long-term complications.

The Strength of the Predictors

The research team used “pooled odds ratios” to quantify the association between each factor and the likelihood of persistent opioid use. Patients enrolled in Medicaid and those with preoperative benzodiazepine use had a 77% higher chance of developing NPOU (Odds ratio: 1.77). Individuals with a history of mood disorders faced 24% higher odds, while those with pre-existing anxiety disorders had 17% greater odds of persistent use.

Yoonjae Lee, DNP, APRN, the lead author, stated, “Identifying who is at risk before the first incision is made is a critical step in combatting the opioid crisis. Our findings provide a roadmap for clinicians to implement targeted interventions, ensuring that high-risk patients receive enhanced monitoring and alternative pain management strategies.”

Expert Insight: This research underscores the complexity of pain management and the need to move beyond simply addressing the physical experience of pain. Recognizing the influence of social determinants of health, like insurance status, and underlying mental health conditions is crucial for preventing unintended long-term consequences for patients.

A More Comprehensive Approach to Preoperative Care

The study highlights that being “opioid-naïve” does not guarantee a patient will avoid long-term opioid use. Researchers advocate for a more holistic preoperative screening process that considers both social and psychological factors alongside the surgical procedure itself. This integrated approach could help prevent the unintended consequences of surgical pain management and improve patient outcomes.

Frequently Asked Questions

What is New Persistent Opioid Use (NPOU)?

NPOU is defined as continued opioid use beyond three months post-surgery and has been linked to increased morbidity, higher mortality rates, and long-term complications.

Which factors were found to be the strongest predictors of NPOU?

Medicaid enrollment and preoperative benzodiazepine use were the strongest predictors, with patients in these categories having 77% higher odds of developing NPOU.

What do the researchers suggest to prevent NPOU?

The researchers advocate for a more comprehensive approach to preoperative screening that considers social determinants and psychological factors, alongside the surgery itself, to implement targeted interventions.

How might a more proactive approach to identifying at-risk patients change the landscape of post-surgical pain management?