Association Between Intra- and Postoperative Opioids in Opioid-Naïve Patients in Thoracic Surgery

Background: As the opioid epidemic continues, a better understanding of the use of opioids in surgery is needed. We examined whether intraoperative opioid administration was associated with greater postoperative opioid use prior to discharge in opioid-naïve patients undergoing thoracic surgery. Further, we sought to determine predictors of higher intra- and postoperative opioid use including demographic and patient factors and hospital.

Methods: Data on patients who underwent elective thoracic surgery between January 1, 2018, and December 31, 2019, were extracted from a data repository at a large health system in the Southeast United States. All patients and data on total intraoperative and postoperative (prior to discharge) opioid administration were included. A total of 126 patient encounters were analyzed.

Results: Increased intraoperative morphine milligram equivalent was associated with increased postoperative administration, where each unit increase in intraoperative morphine milligram equivalent was associated with 0.57 increased units in postoperative use (B = 0.57; 95% CI, 0.29-0.87, < .0003), controlling for patient race, sex, age, weight, Elixhauser comorbidity score, and hospital. Younger age ( < .002), comorbidity ( < .054), and weight ( < .026) were associated with higher intra- and postoperative opioid use, but race ( < .320) and sex ( < .980) were not associated with opioid administration.

Conclusions: Intraoperative opioid use had a significant impact on postoperative opioid use in patients undergoing elective thoracic surgery, even when controlling for age, weight, comorbidities, race, and sex. Substantial variation in both intra- and postoperative opioid administration was noted.