A study led by the Medical University of Vienna has for the first time investigated the frequency of new persistent opioid use after surgery in Austria. The results show that 1.7% of patients continue to take opioids for at least three to six months after surgery, i.e. beyond a period when acute postoperative pain has usually subsided. The study, which was recently published in the journal JAMA Network Open, highlights the need for preventive measures, particularly for at-risk groups.
The research team analysed data from the Austrian social insurance system on 559,096 patients who underwent a total of 642,857 operations between 2016 and 2021, in light of the current opioid crisis in the United States. In this context, the so-called "new persistent opioid use" (NPOU) has emerged as a significant problem. Opioids are highly effective pain medications that carry a high risk of dependency with prolonged use. In the USA, up to seven per cent of patients develop continued opioid use after surgery, i.e. use that persists for at least three to six months after the procedure. "For Austria, but also for Europe as a whole, such data has been lacking so far," explains study first author Razvan Bologheanu (MedUni Vienna's Department of Anaesthesia, Intensive Care Medicine and Pain Medicine), highlighting the starting point of the current data analysis.
Risk particularly high after spinal surgery
The results show that in Austria, 1.7 per cent of patients who did not use opioids immediately before surgery also take painkillers from this group of drugs six months after surgery. "According to our research, as many as 6.8 per cent have developed NPOU after spinal surgery," reports study leader Oliver Kimberger (MedUni Vienna's Department of Anaesthesia, Intensive Care Medicine and Pain Medicine). A significantly increased risk of continued opioid use was also found after joint replacement and abdominal wall hernia surgery. After surgical procedures on the appendix, for example, the rate is 0.3 per cent.
In addition to the type of surgery, age and concomitant illnesses also play a role. Older age, chronic pain and psychiatric illnesses, especially mood and substance use disorders, are significantly associated with postoperative opioid use. People who have taken opioids before surgery and stopped taking them before going to hospital are also particularly likely to be in the NPOU group.
"Our study shows that new persistent opioid use after surgery is also an important issue in Austria, despite the fact that prescription practices are much more restrictive than in the US", say the study authors. "The risk factors for NPOU identified by us should be taken into account in postoperative pain management in order to reduce the risk of opioid dependence."
Publication: JAMA Network Open
New Persistent Opioid Use After Surgery
Razvan Bologheanu, Aylin Bilir, Lorenz Kapral, Felix Gruber, Oliver Kimberger
doi: 10.1001/jamanetworkopen.2024.60794
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2830453