BACKGROUND : New persistent opioid use (NPOU) after surgery may represent a public health issue that adversely affects health outcomes and long-term patient survival. We sought to characterize the risk of NPOU relative to surgical approach among different surgical procedures.

METHODS : Patients who underwent either open (OS) or minimally invasive (MIS) pneumonectomy, pancreatectomy, and colectomy between 2013 and 2020 were identified from the IBM-Marketscan database. NPOU was defined as two subsequent opioid refills within first 90-days and in the following 91- to 180-day period after surgery among opioid naïve patients. Multivariable logistic regression was applied to characterize the association between surgical approach and risk of NPOU.

RESULTS : Among 45,757 patients who underwent surgery (pneumonectomy: 7.6%; pancreatectomy: 7.1%; colectomy: 85.3%), median age was 54 years (IQR: 48-60). Most individuals were female (51.5%) and had a malignant indication (67.3%) for surgery. Overall, 50.7% of patients underwent OS whereas 49.3% had MIS. Subsequently, 4.8% of patients developed NPOU. The likelihood of NPOU was higher among patients who had undergone an open versus MIS (5.9% vs. 3.6%; p<0.001). Patients who had OS had higher 6-month total milligram equivalent doses (OS: 250, IQR 135-600 vs. MIS: 200, IQR 100-421), and days of opioid use (OS: 7, IQR 3-15 vs. MIS: 5, IQR 3-10) (both p<0.001). Relative to OS, MIS was associated with 35% lower odds of NPOU (0.65, 95%CI 0.59-0.71).

CONCLUSION : Around 1 in every 20 patients undergoing surgery experienced NPOU. MIS was associated with fewer days of opioid use and lower dosages which translated into lower NPOU following surgery.