Purpose The current epidemic of prescription opioid misuse has increased scrutiny of postoperative opioid prescribing. Some 6% to 8% of opioid-naïve patients undergoing noncancer procedures develop new persistent opioid use; however, it is unknown if a similar risk applies to patients with cancer. We sought to define the risk of new persistent opioid use after curative-intent surgery, identify risk factors, and describe changes in daily opioid dose over time after surgery. Methods Using a national data set of insurance claims, we identified patients with cancer undergoing curative-intent surgery from 2010 to 2014. We included melanoma, breast, colorectal, lung, esophageal, and hepato-pancreato-biliary/gastric cancer. Primary outcomes were new persistent opioid use (opioid-naïve patients who continued filling opioid prescriptions 90 to 180 days after surgery) and daily opioid dose (evaluated monthly during the year after surgery). Logistic regression was used to identify risk factors for new persistent opioid use. Results A total of 68,463 eligible patients underwent curative-intent surgery and filled opioid prescriptions. Among opioid-naïve patients, the risk of new persistent opioid use was 10.4% (95% CI, 10.1% to 10.7%). One year after surgery, these patients continued filling prescriptions with daily doses similar to chronic opioid users ( P = .05), equivalent to six tablets per day of 5-mg hydrocodone. Those receiving adjuvant chemotherapy had modestly higher doses ( P = .002), but patients with no chemotherapy still had doses equivalent to five tablets per day of 5-mg hydrocodone. Across different procedures, the covariate-adjusted risk of new persistent opioid use in patients receiving adjuvant chemotherapy was 15% to 21%, compared with 7% to 11% for those with no chemotherapy. Conclusion New persistent opioid use is a common iatrogenic complication in patients with cancer undergoing curative-intent surgery. This problem requires changes to prescribing guidelines and patient counseling during the surveillance and survivorship phases of care.

We analyzed data from a national dataset of de-identified commercial insurance claims (Clinformatics® Data Mart (OptumInsight, Eden Prairie, MN) to describe changes in healthcare spending associated with new persistent opioid use after surgery. After accounting for other postoperative complications, new persistent opioid use was independently associated with significantly higher total healthcare spending during the 180 days after surgery (by $2,500 for uncomplicated inpatient procedures and $1,000 for uncomplicated outpatient procedures). This increase was primarily due to higher utilization of ambulatory care and readmissions. Patients with new persistent opioid use also continued to have significantly higher monthly healthcare spending even 180 days after surgery. This is in contrast to other common postoperative complications in which patients return to baseline healthcare spending by 180 days after surgery. Targeted valuebased care initiatives may be required to incentivize early identification and coordinated pathways of care for patients with new persistent opioid use after surgery.

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