• Arnar B Ingason, Amanda L Galenkamp, Freyja Jonsdottir, Gary An, and Martin I Sigurdsson.
• Department of Surgery, University of Vermont Medical Center, Burlington, VT.
• J. Am. Coll. Surg. 2024 Oct 21.

BackgroundOverall, 3-12% of opioid-naïve patients develop persistent opioid use after surgery. It's still unclear whether persistent opioid use after transabdominal surgery is associated with adverse surgical outcomes. We aimed to assess if new persistent opioid use after transabdominal surgery is associated with increased long-term mortality and readmission rates.MethodsOpioid-naïve patients >18 years undergoing transabdominal surgery at Landspitali University Hospital, the only tertiary hospital in Iceland, from 2006-2018 were included. Persistent opioid use was defined as opioid use more than 3 months postoperatively. Inverse probability weighting (IPW) was used to yield balanced study groups accounting for baseline characteristics. Long-term mortality (during median follow-up of 5.2 years) was compared using propensity-weighted Cox regression and readmission within 3-6 months using propensity-weighted logistic regression.ResultsOverall, 3923 patients were included (laparoscopy-2680, laparotomy-1243). Rates of new persistent opioid use were 13.0%. Rates were higher after laparotomy than laparoscopy in the crude analysis but not in the propensity-weighted analysis. New persistent opioid use was associated with higher long-term mortality (hazard ratio 1.84, 95% CI 1.41-2.40) and readmission rates (odds ratio 3.24, 95% CI 2.25-4.76). This was consistent for both patients undergoing laparoscopy and laparotomy. Moreover, there were signs of a dose-response relationship, with patients in higher quartiles of postoperative opioid consumption having higher mortality and readmission rates.ConclusionsNew persistent opioid use following transabdominal surgery was associated with higher rates of mortality and readmission rates. This calls for increased postoperative support for at-risk patients and increased support during transitions of care for these patients.Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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