A Systematic Review of the Relative Frequency and Risk Factors for Prolonged Opioid Prescription Following Surgery and Trauma Among Adults

Abstract

Objective: The aim of this study was to examine the relative frequency of and risk factors for prolonged opioid prescription (Rx-3 6:-1 opioid prescription of any length between 3 and 6 months postevent) and long-term opioid prescription (Rx->6:-1 opioid prescription of any length >6 months postevent) after surgery/trauma. Summary Background Data: Eighty percent of patients undergoing surgery are prescribed opioids; for many this initial time-limited therapy continues for months after surgery. Methods: Included studies were published between January 1998 and April 2018, examined opioid use 3 months after surgery/trauma requiring hospitalization, and considered pre-event opioid prescription status. Empirical studies were identified via a systematic literature search. Two independent reviewers assessed studies for inclusion and conducted data extraction and quality appraisal. Results: Thirty-five of the 10,003 screened articles were included; most were retrospective studies of medicoadministrative databases; all studies were observational. The median relative frequency of Rx-3 6 and Rx->6 was 4.1% and 2.6%, respectively, among patients with no/short-term opioid prescription pre-event and 50.9% and 58.5%, respectively, among patients with prolonged opioid prescription pre-event. Income levels, tobacco dependence, use of antidepressants, and pre-event opioid prescriptions are associated with increased risk of Rx-3 6/Rx->6. The use of benzodiazepines (current use) or muscle relaxants and the presence of alcohol/drug dependence were found to be potential risk factors for Rx-3 6/Rx->6 among patients with no/short-term opioid prescription pre-event. Conclusions: Identified risk factors for Rx-3 6/Rx->6 were predominantly psychosocial factors. This points to the importance of assessing mental and social health before surgery and acutely during hospitalization to ensure safe and optimal recovery.