Association of pre-operative opioid use disorder and postoperative outcomes: a systematic review and meta-analysis

Opioid use disorder may increase the risk of adverse postoperative outcomes, but the magnitude and consistency of this association remain unclear. We performed a systematic review and meta-analysis to evaluate the impact of opioid use disorder on postoperative outcomes across surgical populations.

We searched electronic databases for studies comparing adults (aged ≥ 18 y) with and without opioid use disorder undergoing surgery. Primary outcomes were the incidence of any postoperative pain and composite adverse respiratory outcomes. Secondary outcomes included re-admission rates 30 and 90 days after surgery; in-hospital mortality; duration of hospital stay; and total healthcare costs.

From the 40 included studies, three reported postoperative pain, and 19 reported respiratory outcomes. People with opioid use disorder had higher odds of postoperative pain (OR 2.87, 95%CI 1.63-5.06) and composite adverse respiratory events (OR 2.10, 95%CI 1.64-2.68), both with moderate certainty. Subgroup analyses showed increased risk of pulmonary embolism, pneumonia and other respiratory and pulmonary complications (low to moderate certainty). Low certainty evidence indicated higher 30-day and 90-day re-admission rates, prolonged duration of hospitalisation and higher total healthcare costs associated with opioid use disorder, while in-hospital mortality did not differ significantly (very low certainty).

Our results suggest that opioid use disorder is associated with higher incidence of postoperative pain, increased postoperative complications and greater total healthcare costs, which supports the need for routine pre-operative screening for opioid use disorder and the application of patient-centred, multidisciplinary peri-operative care and pain management.