Perioperative and persistent opioid use after surgery: a scoping review

Area of Science:

• Pain Medicine
• Surgical Outcomes
• Pharmacology

Background:

• Persistent opioid use following surgery is a significant clinical challenge.
• Existing research often overlooks comprehensive perioperative opioid exposure.
• Identifying reliable predictors beyond prior opioid use is crucial.

Purpose of the Study:

• To conduct a scoping review identifying knowledge gaps regarding perioperative opioid use and persistent postoperative opioid use.
• To explore the association between preoperative, intraoperative, and postoperative opioid use and long-term opioid dependence.
• To inform future research directions for mitigating persistent opioid use.

Main Methods:

• Comprehensive database search for prospective studies on perioperative opioid use and persistent use in adult surgical patients.
• Systematic review and synthesis of findings from identified studies.
• Analysis of associations between different perioperative phases of opioid exposure and persistent use.

Main Results:

• A complex relationship exists between perioperative opioid use and persistent postoperative opioid use.
• Preoperative opioid use was correlated with persistent use.
• The impact of intraoperative and short-term postoperative opioid use remains unclear, but 3-month prescriptions predict 6- and 12-month persistent use.

Conclusions:

• Further research is needed to elucidate mediating factors for persistent opioid use in preoperative opioid users.
• The specific roles of intraoperative and inpatient postoperative opioid consumption require investigation.
• Understanding short-term postoperative opioid prescriptions (≤30 days) is vital for risk assessment.