Authors: Nelson DB, Niu J, Mitchell KG, Sepesi B, Hofstetter WL, Antonoff MB, Giordano SH, Mehran RJ, Rice DC
Title: Persistent Opioid Use Among The Elderly After Lung Resection: A SEER-Medicare Study.
Journal: Ann Thorac Surg :-
Date: 2019 Aug 22
PubMed ID: 31445908
Abstract: BACKGROUND: Opioids represent the mainstay for treating postsurgical pain, but can cause significant morbidity in addition to dependency. The aim of the study was to determine the incidence of persistent opioid use following lung surgery. METHODS: Patients who underwent lung resection from 2008-2013 for non-small cell lung cancer were identified in the SEER-Medicare database. Patients were categorized as being chronic, intermittent, or naïve preoperative opioid users using information obtained from Part D records. Persistent opioid use was defined as having a filled opioid prescription between 3-6 months after lung resection. RESULTS: 6,948 patients were identified, among whom 3,946 (56.8%) were opioid-naïve, 2017 (29.0%) were intermittent opioid users, and 985 (14.2%) were chronic opioid users preoperatively. Persistent opioid use (3 - 6 months) after lung resection was high (31%), even among opioid naïve patients (17%). Among those who were previously opioid naïve, independent predictors of persistent opioid use were receipt of adjuvant radiation or chemotherapy, age less than 70, Charlson comorbidity score 1 or 2, and residence in zip codes associated with lower education. Conversely, patients who underwent minimally invasive surgery were less likely to have persistent opioid use. Those with persistent opioid use after surgery did not show any trend towards returning to preoperative opioid utilization for at least the first postoperative year. CONCLUSIONS: Opioid dependence in the over 65-year old population after lung resection is high but was significantly lower among those who received minimally invasive surgery, in addition to other factors.