New persistent opioid use may follow incisional ophthalmic procedures in some patients
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Opioid exposure following incisional ophthalmic surgery in previously opioid-naive patients was associated with new persistent opioid use in some patients, according to a study in Ophthalmology.
“Our study shows that new persistent use of opioids occurs after ophthalmic surgeries,” study co-author Maria A. Woodward, MD, MSc, told Healio/OSN.
Woodward and colleagues conducted a retrospective, claims-based cohort study examining 327,379 opioid-naive patients aged 13 years or older who underwent ophthalmic surgery between Jan. 1, 2012, and June 30, 2017.
Data were reviewed to determine drug dose, duration and number of refills prescribed. New persistent opioid use was defined as “fulfillment of an opioid prescription both in the 90-day and the 91- to 180-day periods following the surgical procedure.”
Initial perioperative opioid fill was found to be independently associated with increased risk for new persistent opioid use (P < .001). A total of 14,841 patients (4.5%) in the study cohort had opioid prescriptions filled in the perioperative period; of those, 498 patients (3.3%) had prescriptions filled in the more than 90-day period following surgery. In contrast, only 0.6% of patients who did not fill a prescription perioperatively were classified as having new persistent opioid use.
Patient characteristics that were also found to increase risk for new persistent use included age 50 to 59 years, female sex, Black race, lower household income, education less than a bachelor’s degree, residence in the West and South, history of tobacco use and greater number of comorbidities.
“Stewardship for opioids is critical for surgeons,” Woodward said. “A brief discussion on pain needs and risks with opioids in the perioperative period may affect real‐world change.”
Perspective
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Cataract surgery has a low complication rate and patients have the expectation of rapid visual rehabilitation with a comfortable, pain-free procedure. Topical anesthesia is widely used but pain is the most commonly reported adverse event, with up to 35% of patients experiencing moderate to severe pain during surgery or in the first few hours after surgery. The associated pain and discomfort are often treated with analgesic medications, including intraoperative or postoperative opioid drugs. In this study, 4.5% of 327,379 patients had an initial experience with opioids and of these patients, 3.4% of patients had continued use of opioids. This study documents that even low exposure to opioids can result in addiction. Ophthalmologists should attempt to avoid the use of opioids and to employ strategies to reduce pain such as intracameral ketorolac, which has been shown to reduce the need for opioids. With the current opioid crisis, any mitigating efforts to reduce opioid use can have a meaningful impact on the overall problem, especially in the vulnerable elderly population undergoing cataract surgery.
References:
Donnenfeld ED, et al. Clin Ophthalmol. 2019;doi:13:2143–2150
Porela-Tiihonen S, et al. Clin Ophthalmol. 2013;doi:10.2147/OPHTH.S47576.
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