Surgery Type for Lung Cancer May Influence Later Opioid Use
Posted: Monday, November 12, 2018
In patients being treated for early-stage lung cancer, opioid addiction may be less likely to develop if they undergo video-assisted thoracoscopic surgery (VATS) rather than more invasive open resection. These results, published in a Research Letter in JAMA Oncology, emerged from an analysis of 2007 to 2013 Surveillance, Epidemiology, and End Results–Medicare data on nearly 4,000 surgically treated patients with non–small cell lung cancer, about evenly divided between the two surgical types.
“The findings suggest that surgical patients should be treated in the least invasive way to limit pain and the need for opioids after surgery and that minimally invasive surgical techniques for lung cancer might reduce the need for opioids compared to traditional open surgery,” stated Emanuela Taioli, MD, PhD, of the Icahn School of Medicine at Mount Sinai (Icahn), New York, in an institutional press release.
A total of 2,766 patients (70.9%) were discharged with an opioid prescription, as per the current standard of care. However, “this treatment is intended as short-term pain control, not to exceed a few weeks after surgery,” reported Stephanie Tuminello, MPH, also of Icahn, and colleagues. Nonetheless, 603 patients (15.5%) had long-term postoperative use of opioids, defined as filling 1 or more prescriptions in the first 90 days after surgery and another prescription in the 90 and 180 days after surgery.
The patients undergoing open resection were significantly more likely to become long-term users. In the adjusted model, patients were significantly less likely to use opioids long term not only if they had VATS (adjusted odds ratio [OR] = 0.69), but if they were older (adjusted OR = 0.96) or had a higher income (adjusted OR = 0.77). In addition, long-term opioid use was more likely in those with a higher comorbidity score (adjusted OR = 1.10) or a previous psychiatric condition (adjusted OR = 1.64).