The incidence of and risk factors for opioid overdose following surgery are of significant concern to the medical community. Understanding these factors is critical to developing strategies to reduce the risk of opioid addiction and overdose in postoperative patients. Research suggests that the risk of opioid overdose on post-surgery medication is influenced by several factors, including the type of surgery, the patient’s preoperative opioid use, and various demographic and clinical characteristics.

A study by Wylie et al. (2022) examined the incidence of opioid dependence and overdose in opioid-naive surgical patients who were prescribed opioids postoperatively. The study found that 0.19% of these patients developed opioid dependence or experienced overdose, likely attributable to their post-surgery prescriptions, with the highest risk occurring 1 to 2 years after surgery. Key risk factors identified included continued opioid use 3 to 12 months after surgery, patient age, and type of surgery. Continued opioid use within the first year was significantly associated with a higher likelihood of developing opioid dependence or overdose (1). Though opioid medication is often a necessity after surgery, it can also increase the risk of overdose or other adverse opioid-related effects.

Sun et al. (2016) conducted a comprehensive analysis of continued opioid use in opioid-naive patients after various surgical procedures. The study found that the incidence of chronic opioid use varied by procedure type, with higher rates observed in patients undergoing total knee arthroplasty and other major surgeries. Risk factors for chronic opioid use included male gender, age over 50 years, and preoperative history of drug abuse, alcohol abuse, depression, and use of benzodiazepines or antidepressants (2). Similarly, in a cross-sectional study with longitudinal outcomes, Dunn et al. (2018) examined chronic opioid use after major spine surgery. This study found that 27.9% of patients were opioid-naive before surgery, and of these, 18.3% became chronic opioid users postoperatively. Factors significantly associated with chronic opioid use included preoperative opioid use and higher postoperative pain scores, highlighting the importance of identifying patients at risk for chronic opioid use in order to implement targeted interventions (3).

Brummett et al. (2017) examined new, persistent opioid use following minor and major surgical procedures. It was determined that rates of persistent opioid use were similar for minor and major surgery, but significantly higher compared to non-surgical controls, demonstrating the impact of surgery itself on opioid use and addiction. In this study, risk factors for persistent opioid use included preoperative tobacco use, alcohol and substance abuse disorders, mood disorders, anxiety, and preoperative pain disorders (4). Furthermore, Mudumbai et al. (2018) examined the risk of opioid overdose among surgical patients in the Veterans Health Administration. The study found that the incidence of overdose was significantly higher in the first 30 days after discharge compared to the subsequent period. Higher-intensity opioid use was associated with an increased risk of overdose, with short- and long-acting opioid combinations posing the greatest risk. These findings suggest the importance of cautious opioid prescribing and monitoring in the immediate postoperative period to prevent overdose (5).

In conclusion, opioid overdose and chronic use after surgery are significant health concerns that are influenced by a variety of factors such as type of surgery, preoperative opioid use, and patient demographics. Effective pain management strategies and careful monitoring of at-risk patients are essential to mitigate these risks.

References

1. Wylie JA, Kong L, Barth RJ Jr. Opioid Dependence and Overdose After Surgery: Rate, Risk Factors, and Reasons. Ann Surg. 2022;276(3):e192-e198. doi:10.1097/SLA.0000000000005546
2. Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period [published correction appears in JAMA Intern Med. 2016 Sep 1;176(9):1412. doi: 10.1001/jamainternmed.2016.5221] [published correction appears in JAMA Intern Med. 2022 Jun 1;182(6):690. doi: 10.1001/jamainternmed.2022.0812] [published correction appears in JAMA Intern Med. 2022 Jul 1;182(7):783. doi: 10.1001/jamainternmed.2022.1632]. JAMA Intern Med. 2016;176(9):1286-1293. doi:10.1001/jamainternmed.2016.3298
3. Dunn LK, Yerra S, Fang S, et al. Incidence and Risk Factors for Chronic Postoperative Opioid Use After Major Spine Surgery: A Cross-Sectional Study With Longitudinal Outcome. Anesth Analg. 2018;127(1):247-254. doi:10.1213/ANE.0000000000003338
4. Brummett CM, Waljee JF, Goesling J, et al. New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults [published correction appears in JAMA Surg. 2019 Mar 1;154(3):272. doi: 10.1001/jamasurg.2018.5476]. JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504
5. Mudumbai SC, Lewis ET, Oliva EM, et al. Overdose Risk Associated with Opioid Use upon Hospital Discharge in Veterans Health Administration Surgical Patients. Pain Med. 2019;20(5):1020-1031. doi:10.1093/pm/pny150