Surgical patients discharged with opioids have higher death risk, study finds

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A broad research collaboration in Hong Kong has investigated the links between opioid prescriptions given at discharge after surgery and the enduring use of opioids, health service needs, and mortality rates.

This examination has shone light on the critical need for careful consideration and dialogue around postoperative pain management strategies.

The Study

The team was composed of members from multiple departments at the University of Hong Kong (HKUMed) and the Laboratory of Data Discovery for Health (D²4H).

They engaged in an extensive retrospective study, exploring the long-term implications of opioid prescriptions post-surgery, covering the period from 1 January 2000 to 30 November 2020.

Examining data from 438,128 patients who underwent surgery, the study found that 7.52% of these patients received an opioid prescription at discharge.

From these, a higher percentage reported persistent use of opioids, emergency visits within 30 days, 30-day hospital readmission, and even death within 30 days post-surgery, compared to those who did not receive opioids at discharge.

The Findings and Clinical Risks

According to the study, opioid prescription at discharge presents clinical risks leading to prolonged opioid use, unplanned health service use, and increased mortality.

This discovery is significant, considering that opioids are often suggested for managing moderate to severe pain following surgery.

The real-world impact of opioid use at discharge has been somewhat obscure, and this study provides crucial insights into the potential adverse effects and increased healthcare utilization associated with opioid prescription after surgery.

Considerate and Informed Decision-Making

Even with these risks, opioids remain a relevant option for managing pain after major surgery, highlighting the need for balanced and informed decisions.

Patients should be actively involved in discussions about the length, side effects, and possible alternatives to opioid use, such as multimodal analgesia, which involves medications from different classes, and alternative pain management methods.

This active dialogue ensures patients are well-informed about the benefits and risks of opioid use and other available pain management strategies.

Professor Brian Lang Hung-hin emphasized the importance of understanding the pros and cons of different treatment options and exploring non-opioid pain relief medications, physical therapy, and cognitive-behavioral therapy as alternatives.

Such interactions allow patients to weigh the relief provided by opioids against the associated risks and consider alternatives before deciding to use opioids.

Conclusion and Recommendations

The insights provided by this retrospective study spotlight the repercussions of opioid use post-surgery, suggesting a need for optimal and well-considered use of opioids in postoperative pain management.

Dr. Carlos Wong King-ho stressed that the study’s findings support the rational use of opioids due to the increased healthcare utilization and adverse clinical outcomes following their use post-operation.

This study serves as a reminder for both healthcare providers and patients to explore alternative pain relief options, discuss and develop collaborative plans for pain management that carefully balance pain relief benefits against the associated risks.

Multimodal analgesia, involving non-opioid-based analgesics and regional block, should be considered as viable alternative strategies for managing postoperative pain.

In summary, the decisions surrounding postoperative pain management should be made with due diligence, careful consideration of available options, and open conversations between patients and healthcare providers, aiming for an optimal balance between pain relief and associated risks.

If you care about pain management, please read studies about The battle with pain: a different look at opioids and findings of New rules for pain medicine use: what you need to know.

For more information about wellness, please see recent studies that Krill oil could improve muscle health in older people, and eating yogurt linked to lower frailty in older people.

The research findings can be found in the British Journal of Anaesthesia.

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