Association of pre-operative opioid use disorder and postoperative outcomes: a systematic review and meta-analysis.

Abstract

Introduction: Opioid use disorder may increase the risk of adverse postoperative outcomes, but the magnitude and consistency of this association remain unclear. We performed a systematic review and meta-analysis to evaluate the impact of opioid use disorder on postoperative outcomes across surgical populations.

Methods: We searched electronic databases for studies comparing adults (aged ≥ 18 y) with and without opioid use disorder undergoing surgery. Primary outcomes were the incidence of any postoperative pain and composite adverse respiratory outcomes. Secondary outcomes included re-admission rates 30 and 90 days after surgery; in-hospital mortality; duration of hospital stay; and total healthcare costs.

Results: From the 40 included studies, three reported postoperative pain, and 19 reported respiratory outcomes. People with opioid use disorder had higher odds of postoperative pain (OR 2.87, 95%CI 1.63-5.06) and composite adverse respiratory events (OR 2.10, 95%CI 1.64-2.68), both with moderate certainty. Subgroup analyses showed increased risk of pulmonary embolism, pneumonia and other respiratory and pulmonary complications (low to moderate certainty). Low certainty evidence indicated higher 30-day and 90-day re-admission rates, prolonged duration of hospitalisation and higher total healthcare costs associated with opioid use disorder, while in-hospital mortality did not differ significantly (very low certainty).

Discussion: Our results suggest that opioid use disorder is associated with higher incidence of postoperative pain, increased postoperative complications and greater total healthcare costs, which supports the need for routine pre-operative screening for opioid use disorder and the application of patient-centred, multidisciplinary peri-operative care and pain management.