Opioid Use After Surgery: Insights from an Austrian Study

Opioid use after surgery is a topic of increasing concern worldwide, especially in the context of the opioid epidemic. New persistent opioid use (NPOU), defined as continued opioid use three to six months after surgery beyond the typical recovery period, presents significant challenges for healthcare systems and patients alike. While much research has focused on the United States and the UK, there is limited data about how NPOU occurs in other healthcare systems, such as Austria. Understanding these patterns and the associated risk factors can help create better strategies for pain management and reduce the long-term risks of opioid misuse.

This blog explores the findings of a recent nationwide study conducted in Austria, shedding light on the incidence of NPOU, contributing factors, and what it means for global healthcare systems.

The Scope of Opioid Use After Surgery

Postoperative opioids, often prescribed for pain management, are one of the primary contributors to long-term opioid use. Even low-risk surgeries like hernia repair or appendectomy can lead to patients becoming long-term opioid users. For example, the Austrian study revealed that persistent opioid use was documented in 1.7% of patients after surgery. This rate is significantly lower than the 4.1%–7.1% commonly reported in the US but still represents a significant issue, especially considering its potential to lead to addiction or misuse.

While the numbers may seem small, they add up quickly when applied to the millions of surgeries performed each year. Persistent opioid use can burden healthcare systems and highlight the need for better postoperative pain management strategies globally.

Factors Contributing to Persistent Opioid Use

NPOU is rarely the result of a single factor. The Austrian study identified multiple patient and procedural characteristics that increase the likelihood of new persistent opioid use after surgery.

Previous Opioid Use

Patients with a history of opioid use discontinued prior to surgery are at higher risk of developing NPOU. The study reported these individuals as three times more likely to experience persistent use compared to opioid-naïve patients.

Substance Use Disorder and Psychiatric Conditions

Patients with a history of mood disorders or substance use disorders had an elevated risk of developing NPOU. Mental health issues may amplify the physiological and psychological aspects of pain, making these individuals more reliant on opioids.

Age and Gender

Older adults were more likely to develop persistent opioid use, likely due to increased surgical complications or extended recoveries. Intriguingly, the study also found that men were slightly less likely than women to persistently use opioids post-surgery.

Type of Surgery

Certain surgeries were associated with a much higher risk of NPOU. For instance, spinal surgeries had the highest incidence (6.8%), with arthroplasties such as joint replacements also identified as significant contributors.

Length of Hospital Stay

A prolonged hospital stay post-surgery was another indicator of NPOU. Longer hospitalizations may signify more severe pain that requires extended management, often through opioids.

Open vs. Minimally Invasive Procedures

Open surgical methods carried a slightly higher risk of persistent opioid use compared to minimally invasive techniques, primarily due to more significant pain during recovery.

Systemic and Regional Factors

Interestingly, the Austrian study found that regional prescribing practices play a significant role in the lower overall rates of NPOU compared to North America. Austria follows stricter opioid prescribing practices, which likely contributed to the lower incidence rates.

Key Takeaways for Reducing Opioid Misuse

The Austrian study provides valuable lessons for healthcare systems globally:

Implement Stricter Prescribing Regulations

Countries with more stringent opioid prescribing policies, like Austria, have lower rates of NPOU. Limiting the quantity and duration of opioid prescriptions post-surgery could help reduce long-term use.

Individualised Pain Management

Custom-tailored pain management plans, which include alternatives like physical therapy or non-opioid medications, can help minimise opioid reliance.

Enhanced Monitoring

Patients with a history of opioid use, psychiatric conditions, or advanced age might benefit from enhanced monitoring during and after surgery to mitigate the risks of persistent use.

Education for Patients and Clinicians

Educating healthcare providers and patients about the risks of NPOU and the importance of using the lowest effective dose for the shortest possible duration may reduce misuse.

Comparative System Evaluations

Additional comparative studies across different healthcare systems could reveal how systemic or organisational differences influence NPOU incidence. Such research could help pinpoint the most effective strategies for reducing opioid-related health burdens.

Shifting Towards a Safer Postoperative Future

The Austrian study demonstrates that while stricter prescribing practices can help reduce NPOU rates, systemic and patient-specific factors also play a crucial role. For healthcare systems in regions like North America, where persistent opioid use remains more prevalent, there is a clear need to adopt multi-faceted approaches to pain management. Taking patient history into account, offering non-opioid alternatives, and creating stricter guidelines for opioid prescriptions are essential steps in combating this growing issue.

Source: JAMA Network