Open versus minimally invasive surgery: risk of new persistent opioid use

BACKGROUND: New persistent opioid use (NPOU) after surgery may represent a public health issue that adversely affects health outcomes and long-term patient survival. This study aimed to characterize the risk of NPOU relative to surgical approach among different operative procedures. METHODS: Patients who underwent either open (open surgery OS) or minimally invasive (minimally invasive surgery MIS) pneumonectomy, pancreatectomy, and colectomy between 2013 and 2020 were identified from the IBM MarketScan database. NPOU was defined as 2 subsequent opioid refills within the first 90-day period, as well as in the following 91- to 180-day period after surgery among opioid-naive patients. Multivariate logistic regression was used to characterize the association between the surgical approach and the risk of NPOU. RESULTS: Among 45,757 patients who underwent surgery (pneumonectomy: 7.6%; pancreatectomy: 7.1%; colectomy: 85.3%), median age was 54 years (IQR, 48-60). Most individuals were female (51.5%) and had a malignant indication (67.3%) for surgery. Overall, 50.7% of patients underwent OS, whereas 49.3% of patients underwent MIS. Subsequently, 4.8% of patients developed NPOU. The likelihood of NPOU was higher among patients who underwent OS than among individuals who underwent MIS (5.9% vs 3.6%, respectively; P < .001). Patients who underwent OS had higher 6-month total milligram equivalent doses (OS: 250 IQR, 135-600 vs MIS: 200 IQR, 100-421) and days of opioid use (OS: 7 IQR, 3-15 vs MIS: 5 IQR, 3-10) (both P < .001). Relative to OS, MIS was associated with 35% lower odds of NPOU (0.65; 95% CI, 0.59-0.71). CONCLUSION: 1 in 20 patients who underwent surgery experienced NPOU. MIS was associated with fewer days of opioid use and lower dosages, which translated into lower NPOU after surgery.