Long-term Health Outcomes of New Persistent Opioid Use After Gastrointestinal Cancer Surgery

Abstract

Background New persistent opioid use (NPOU) after surgery has been identified as a common complication. This study sought to assess the long-term health outcomes among patients who experienced NPOU after gastrointestinal (GI) cancer surgery. Methods Patients who underwent surgery for hepato-pancreato-biliary and colorectal cancer between 2007 and 2019 were identified using the Surveillance, Epidemiology, and End Results (SEER)-Medicare-linked database. Mixed-effect multivariable logistic regression and Cox proportional hazard models were used to estimate the risk of mortality and hospital visits related to falls, respiratory events, or pain symptoms. Results Among 15,456 patients who underwent GI cancer surgery, 967(6.6%) experienced NPOU. Notably, the patients at risk for the development of NPOU were those with a history of substance abuse (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.14–1.84), moderate social vulnerability (OR, 1.26; 95% CI, 1.06–1.50), an advanced disease stage (OR, 4.42; 95% CI, 3.51–5.82), or perioperative opioid use (OR, 3.07; 95% CI, 2.59–3.63. After control for competing risk factors, patients who experienced NPOU were more likely to visit a hospital for falls, respiratory events, or pain symptoms (OR, 1.45, 95% CI 1.18–1.78). Moreover, patients who experienced NPOU had a greater risk of death at 1 year (hazard ratio [HR], 2.15; 95% CI, 1.74–2.66). Conclusion Approximately 1 in 15 patients experienced NPOU after GI cancer surgery. NPOU was associated with an increased risk of subsequent hospital visits and higher mortality. Targeted interventions for individuals at higher risk for NPOU after surgery should be used to help mitigate the harmful effects of NPOU.

ASO Author Reflections: Long-term Health Outcomes of New Persistent Opioid Use After Gastrointestinal Cancer Surgery

“…4 The results of the current study underscore the importance of preoperative risk stratification and comprehensive perioperative pain management plans to prevent NPOU. 4 In the preoperative setting, patients should be screened for NPOU risk factors, and if opioids are prescribed, there is a need for close monitoring. 5,6 Additionally, surgical pain may be managed through multimodal analgesia, with a focus on nonopioid medications, such as acetaminophen, nonsteroidal antiinflammatory drugs, gabapentin, and ketamine.…”

“…Roughly 1 in 15 patients develop NPOU following gastrointestinal cancer surgery. 4 NPOU is associated with a greater likelihood of mortality and hospital visits because of falls, respiratory complications, and pain symptoms. 4 The results of the current study underscore the importance of preoperative risk stratification and comprehensive perioperative pain management plans to prevent NPOU.…”

“…4 NPOU is associated with a greater likelihood of mortality and hospital visits because of falls, respiratory complications, and pain symptoms. 4 The results of the current study underscore the importance of preoperative risk stratification and comprehensive perioperative pain management plans to prevent NPOU. 4 In the preoperative setting, patients should be screened for NPOU risk factors, and if opioids are prescribed, there is a need for close monitoring.…”