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Prevalence of preoperative opioid usage and its impact on postoperative outcomes: a retrospective cohort study

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Abstract

Purpose

Preoperative opioid treatment increases postoperative adverse events. This study was aimed to analyze preoperative opioid prevalence in countries with low opioid consumption. Additionally, the effect of low opioid usage on postoperative outcomes was also investigated.

Methods

We conducted this single center retrospective cohort analysis in a Japanese university-affiliated hospital to investigate opioid usage and its impact on the duration of postoperative hospitalization and in-hospital mortality. Adult patients who underwent general anesthesia between 2015 and 2020 were included. We extracted the patients’ characteristics, surgical information and postoperative outcomes. Subgroup analysis to address opioid dose effect was performed in high and low dose opioid subgroups.

Results

Among 20,306 inpatients, 535 (2.63%) patients used opioids preoperatively. Tramadol was the most frequently used opioid. The median morphine equivalent (MME) dose was 15 mg/day. Median duration of hospitalization was 18 and 9 days in the opioid and non-opioid groups, and in-hospital mortality was 2.06% and 0.42%. Multivariable regression analysis demonstrated that preoperative opioid use was associated with a longer duration of hospitalization and in-hospital mortality. Subgroup analysis demonstrated longer durations of hospitalization in both high (> 30 mg/day MME) and low (≤ 30 mg/day MME) dose opioid groups, while higher in-hospital mortality was seen only in the high dose opioid group.

Conclusions

Preoperative opioid usage was one-tenth of the United States average. Despite its low prevalence and small dosage, preoperative opioid usage was associated with poor postoperative outcomes. Dedicated perioperative interventions to prevent opioid-associated adverse events should be developed even in countries with low opioid consumption.

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Data availability

Data will be available upon reasonable request to corresponding author.

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Acknowledgements

FA was supported by Grants-in-Aid for Scientific Research, Japan Society for Promotion of Science (20K21635 and 21H03026).

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Authors and Affiliations

  1. Department of Pain Management and Palliative Care Medicine, Kyoto Prefectural University of Medicine, Kajiicho 465, Kamigyo-ku, Kyoto, 602-0841, Japan

    Rina Oya, Satoru Ogawa, Yuka Hirakawa, Chika Maeda & Fumimasa Amaya

  2. Peace Home Care Clinic, 16-21 Oiwake-cho, Otsu, Shiga, 520-0064, Japan

    Kiyofumi Oya

Authors
  1. Rina Oya
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  2. Satoru Ogawa
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  3. Kiyofumi Oya
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  4. Yuka Hirakawa
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  6. Fumimasa Amaya
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Contributions

RO: designed the study protocol, conducted the investigation, analyzed the data, and contributed to writing the article. FA: designed the study protocol and contributed to writing the article. SO, YH and CM: contributed to analyzing the data and writing the article. KO: analyzed the data. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fumimasa Amaya.

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Conflict of interest

FA received speaker fees from Shionogi Inc. The other authors report no conflicts of interest in relation to this study.

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Oya, R., Ogawa, S., Oya, K. et al. Prevalence of preoperative opioid usage and its impact on postoperative outcomes: a retrospective cohort study. J Anesth 37, 532–538 (2023). https://doi.org/10.1007/s00540-023-03198-0

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  • DOI: https://doi.org/10.1007/s00540-023-03198-0

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