New persistent opioid use after colorectal surgery in Sweden: A nationwide register-based cohort study.

AIM: To determine the incidence of new persistent opioid use (NPOU) after elective colorectal surgery in Sweden and to identify associated patient-, procedure- and hospital-level factors.

METHOD: This nationwide retrospective cohort study linked data from Swedish national health registries and included adults undergoing elective inpatient colorectal surgery between 2018 and 2022. Patients with an opioid dispensed 365 to 30 days before surgery, another surgical procedure within one year of the index operation, or death within 12 months postoperatively were excluded. NPOU was defined as at least one opioid dispensed within 90 days after surgery and at least one between 90 and 180 days. Associations were examined using multivariable logistic regression.

RESULTS

Among 14,233 opioid-naïve patients, 374 (2.63%; 95% CI, 2.37-2.90%) developed NPOU. Longer operating time (aOR, 1.19 per hour; 95% CI, 1.13-1.26), preoperative non-opioid analgesics (aOR, 1.90; 95% CI, 1.52-2.37) or sedatives/anxiolytics (aOR, 1.66; 95% CI, 1.31-2.09), opioid dispensation within 7 days of surgery (aOR, 2.19; 95% CI, 1.76-2.72), and higher ASA classification (ASA 3: aOR, 1.89; 95% CI, 1.26-2.90; ASA 4: aOR, 3.29; 95% CI, 1.63-6.36) were independently associated with higher odds of NPOU, whereas male sex was associated with lower odds (aOR, 0.76; 95% CI, 0.61-0.95).

CONCLUSION

In this low-prescribing setting, approximately one in 38 opioid-naïve patients developed NPOU 6 months after colorectal surgery. Operating time and opioid dispensation within 7 days of surgery were independently associated with NPOU; the latter, a modifiable prescribing decision, is a plausible target for opioid-sparing strategies.