Prevalence and risk factors for persistent opioid use after thoracic surgery: A retrospective cohort study in a prefecture of Japan.

Objective: Thoracic surgery is known to lead to post-operative opioid dependence in countries with high opioid consumption; however, there are limited reports from countries with moderate to low opioid consumption, such as Japan. This study aimed to investigate the prevalence and risk factors for persistent opioid use after thoracic surgery in Japan.

Design: A retrospective cohort study using linked medical claims data from the National Health Insurance in Ibaraki Prefecture, Japan.

Patients: Patients aged ≥18 who underwent thoracic (mediastinal or lung) surgery between October 2012 and September 2021 were included in this study.

Main outcome measures: Persistent opioid use was defined as prescription from 0 to 14 days after surgery and 91 to 180 days after surgery. We evaluated associated factors using multivariable logistic regressions.

Results: Among the 6,041 patients who underwent thoracic surgery during the study period, 3,924 were included in the final analysis. The median age was 68 years (range, 64-71 years), and 2,316 (61.0 percent) were male. Persistent opioid use was recorded in 130 (3.3 percent). Multivariable analyses identified neoadjuvant therapy (chemotherapy or radiotherapy) (odds ratio [OR], 2.02; 95 percent confidence interval [CI], 1.09-3.77; p = 0.027) and thoracotomy (vs video-assisted thoracoscopic surgery) (OR, 1.50; 95 percent CI, 1.01-2.24; p = 0.046) as independent risk factors for persistent opioid use.

Conclusions: In a prefecture of Japan, 3.3 percent of patients who underwent thoracic surgery developed persistent opioid use. Neoadjuvant therapy (chemotherapy or radiotherapy) and thoracotomy were independent factors associated with persistent opioid use. Individualized perioperative pain management strategies should be considered for high-risk patients.