Abstract
Background: Opioid prescribing guidance primarily focuses on patients with non-cancer pain. Patients undergoing surgery for cancer may have a higher risk of persistent postoperative opioid use compared to patients undergoing similar procedures for other indications.
Methods: This was a retrospective analysis of Medicaid claims data for patients undergoing colorectal surgery between 2015-2018. Included patients were assigned to a cancer or non-cancer cohort based on International Classification of Disease 9 or 10 codes indicating cancer or other relevant disease (e.g., Crohn’s disease). Multivariable logistic regression was used to assess the rate of persistent postoperative opioid use, defined as an opioid prescription between 90 and 180 days after surgery.
Results: This analysis included 1,929 patients: 891 in the cancer cohort and 1,038 in the non-cancer cohort. Adjusting for other relevant variables, patients undergoing surgery for cancer were significantly more likely to develop persistent postoperative opioid use (OR 1.35, 95% CI 1.08 to 1.69). Other variables associated with increased likelihood of the primary endpoint were opioid use within 30 days prior to hospitalization (OR 3.00, 95% CI 2.34 to 3.85), laparoscopic proctocolectomy or open colectomy (OR 2.66, 95% CI 1.19 to 5.91 and OR 1.75, 95% CI 1.37 to 2.23 compared to laparoscopic colectomy, respectively), and hospital drive distance over 60 miles (OR 1.72, 95% CI 1.26 to 2.32).
Discussion: Persistent opioid use was more likely in patients undergoing surgery for cancer. Guidelines for opioid prescribing should be inclusive to cancer patients to prevent undesired outcomes.