The Patterns and Trajectory of Continued Opioid Use in Opioid-Naïve Patients After Curative-Intent Elective Cancer Surgery-A Prospective Cohort Study.

BACKGROUND

Post-discharge opioid use patterns in opioid-naïve patients following cancer surgery remain poorly characterized, particularly during the early transition period after discharge.

AIM: To determine the prevalence of continued opioid use 7 days after discharge and to identify predictors and cessation trajectories over 30 days post-discharge.

METHODS

A prospective single-center cohort study enrolled opioid-naïve patients undergoing curative-intent elective cancer surgery across three surgical specialties (breast, gynecological oncology, and head and neck) between June 2021 and January 2023. The primary outcome was patient-reported opioid use at Day 7 post-discharge. Multivariable logistic regression identified independent predictors; Kaplan-Meier analysis estimated time-to-cessation by pre-discharge opioid exposure group.

RESULTS

Among 107 opioid-naïve patients, 42% continued opioid use beyond 7 days. Patients who continued opioids had higher pain interference, more opioid-related adverse events, and higher opioid consumption during 24 h prior to discharge (p < 0.05). In multivariable analysis, having opioids in 24 h prior to discharge (adjusted odds ratio [aOR] 4.46; 95% CI 1.56-12.7), first-time cancer surgery (aOR 6.06; 95% CI 1.45-25.6), and higher stage of cancer (aOR 1.50; 95% CI 1.00-2.23) were independently associated with continued opioid use. Kaplan-Meier graph analysis demonstrated significantly different cessation trajectories between pre-discharge opioid exposure groups (log rank p < 0.001).

CONCLUSION

Continued opioid use in the first week following cancer surgery is common. Pre-discharge opioid exposure and disease burden independently predict delayed cessation. Opioid use in the final 24 h before discharge represents a practical, clinically accessible signal for risk stratification and individualized opioid stewardship.