Use of opioids before surgery predicts consumption of opioids after surgery

As elective surgeries deferred due to the COVID-19 pandemic begin to ramp up, a new study from University of Michigan Medical School researchers details important considerations for surgical patients with recent opioid use versus those who have never taken opioids. The study, led by Mark Bicket, M.D., Ph.D., of the U-M Health Department of Anesthesiology, Jennifer Waljee, M.D., M.P.H., M.S., with the Department of Surgery at University of Michigan Medical School and their colleagues examined data from 26,001 adults over the age of 18 who underwent one of nine elective surgeries during the two years prior to the pandemic.

Data was pulled from the Michigan Surgical Quality Collaborative and linked to the state prescription drug monitoring program using specialty methods to protect the confidentiality of the data.

"Individuals who take prescription opioids before surgery may have unique needs to treat pain after surgery, and this study provides data for the first time on how many pills these patients report needing to take after discharge from surgery," said Bicket.

The study team found that compared to patients who had not taken opioids, those who had used the medications in the year prior to their surgery consumed more opioid drugs 30 days after their surgery, had more prescriptions and more refills.

Furthermore, the number of opioid pills consumed after surgery trended with opioid use prior to surgery, with patients with chronic exposure (defined as use for nine months or more) having the most use after their procedure. Overall, the pain medication needs for most patients who took opioids before surgery would be addressed through recommendations in the current guidelines, but patients with chronic exposure may need special recommendations for how much to prescribe after surgery. Additionally, patients who used opioids prior to surgery had more comorbidities, including greater body mass index and diagnoses such as chronic obstructive pulmonary disease. The findings point to a need to further tailor opioid prescribing guidelines to account for prior use to balance optimal pain relief with the need to prevent the oversupply of prescription opioid drugs.

Paper cited: "Association of opioid exposure before surgery with opioid consumption after surgery," BMJ: Regional Anesthesia & Pain Medicine. DOI: 10.1136/rapm-2021-103388