Abstract
Background:
Thoracic surgery is known to lead to postoperative opioid dependence in countries with high opioid consumption; however, there are limited reports from countries with moderate to low opioid consumption, such as Japan. This study aimed to investigate the prevalence and risk factors for persistent opioid use after thoracic surgery in Japan.
Methods:
We conducted a retrospective cohort study using linked medical claims data of individuals covered by the National Health Insurance in Ibaraki Prefecture, Japan. The participants were patients aged ≥ 18 years who underwent thoracic (mediastinal or lung) surgery between October 2012 and September 2021. Based on previous studies, persistent opioid use was defined as opioid prescription from both (i) 0 to 14 days after surgery and (ii) 91 to 180 days after surgery. Multivariable logistic regression analyses were conducted to assess the factors associated with persistent opioid use.
Results:
Among the 6041 patients who underwent thoracic surgery during the study period, 3924 were included in the final analysis. The median age was 68 years (range, 64–71 years) and 2316 (61.0%) were male patients. Among the patients included in the final analysis, 130 (3.3%) developed persistent opioid use. Multivariable analysis showed that neoadjuvant therapy (chemotherapy or radiotherapy) (odds ratio [OR], 2.02; 95% confidence interval [CI], 1.09–3.77; P = 0.027) and thoracotomy (vs video-assisted thoracoscopic surgery) (OR, 1.50; 95% CI, 1.01–2.24; P = 0.046) were independent risk factors for persistent opioid use.
Conclusions:
In a prefecture of Japan, 3.3% of patients who underwent thoracic surgery developed persistent opioid use. Neoadjuvant therapy (chemotherapy or radiotherapy) and thoracotomy were independent factors associated with persistent opioid use after thoracic surgery. Individualized perioperative pain management strategies should be considered for high-risk patients.