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.