Objective: To determine the association between persistent post-operative opioid use and the long-term risk of opioid use disorder and opioid overdose.
Summary background data: Persistent post-operative opioid use is a commonly used outcome in the surgical literature; its incidence and risk factors have been well described. However, its association to long term outcomes, including opioid use disorder and opioid overdose, is unknown.
Methods: A retrospective cohort study utilizing the Veterans Health Administration corporate data warehouse. Patients undergoing any surgery between January 1st 2008 and December 31st 2018 were included and followed until December 31st 2020. Univariate and multivariate survival analysis were used to determine the association between persistent post-operative opioid use and opioid use disorder and overdose. Sensitivity analyses were conducted to determine the impact of different definitions of persistent opioid use and the effect of pre-operative opioid use.
Results: 304,780 patients undergoing surgery were included and followed for a median of 5.56 years (IQR 3.08-8.65). Persistent post-operative opioid use was associated with an increased hazard of developing both opioid use disorder (HR = 1.88, CI: 1.80-1.96, p < 0.001) and overdose (HR = 1.78, CI: 1.67-1.90, p < 0.001). This association remained consistent after adjustment for comorbidities and across all sensitivity analyses.
Conclusions: Surgical patients who develop persistent post-operative opioid use are at increased risk of both opioid use disorder and overdose as compared to surgical patients who do not develop persistent use.
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