Preoperative Opioid Use Linked to Small Increase in Postsurgical Opioid Consumption

Close up of the one round white pill in female hand. Woman takes medicines with glass of water.
Existing guidelines for postsurgical opioid use likely meet needs of most patients with preoperative opioid exposure.

Preoperative opioid use was linked to higher rates of patient-reported postoperative opioid consumption, according to a population-based cohort study, published in Regional Anesthesia & Pain Medicine.

Patients (N=26,001) who were undergoing one of nine surgical procedures between 2017 and 2019 at the >70 hospitals participating in the Michigan Surgical Quality Collaborative (MSQC) and had linked data in the state’s prescription drug monitoring program were included in this study. Postoperative 30-day patient-reported opioid consumption was assessed on the basis of 1-year preoperative opioid exposure.

The patient population comprised 57% women, aged mean 53.8 (standard deviation [SD], 16.4) years, 83% were White, and 25% underwent urgent surgery. Stratified by preoperative (n=6800) and no preoperative (n=19,201) opioid exposure, patients who used opioids prior to surgery were more likely to women, have coronary artery disease, chronic obstructive pulmonary disease, diabetes, hypertension, peripheral vascular disease, sleep apnea, to use tobacco, to be immunosuppressed, and less likely to require dialysis, have deep vein thrombosis, or pulmonary embolus (P <.001 for all).

Presurgical opioid exposure was associated with elective surgery (79% vs 74%; P <.001).

At discharge, preoperative opioid-exposed patients were prescribed opioids at discharge more often (81% vs 66%) and were given larger quantities of opioids (median oral morphine equivalents [OME], 100 vs 60).

The exposed patients reported consuming more opioids (median OME, 25 vs 10; P <.001). After adjusting for demographic, clinical, and surgical characteristics, the opioid-exposed patients consumed 11.9 (95% CI, 9.8-14.0) OMEs more than the unexposed cohort (adjusted odds ratio [aOR], 1.16; 95% CI, 1.09-1.24).

Patients who had chronic opioid exposure before surgery had the largest increase in opioid consumption compared with patients without presurgical exposure (median OME, 31.8; 95% CI, 21.3-42.2).

The opioid-exposed and naïve cohorts refilled their opioid prescription 0 times (61% vs 90%), once (24% vs 9%), twice (11% vs 1%), and 3 or more times (4% vs 0.4%), respectively. The opioid exposed patients had an increased likelihood of receiving a refill (aOR, 4.74; 95% CI, 4.36-5.15) and refilling their prescription (adjusted incidence rate ratio [aIRR], 3.97; 95% CI, 3.71-4.25).

This study may have been limited by the reliance on patient-reported consumption.

These data indicated that for patients undergoing general and gynecologic surgery, presurgical exposure to opioids during the year before surgery increased postoperative opioid consumption. Clinicians should consider preoperative exposure and opioid stewardship should be employed when prescribing postoperative pain management.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Bicket MC, Gunaseelan V, Lagisetty P, et al. Association of opioid exposure before surgery with opioid consumption after surgery.Reg Anesth Pain Med. 2022;rapm-2021-103388. doi:10.1136/rapm-2021-103388