In a study reported in a research letter in JAMA Oncology, Stephanie Tuminello, MPH, and colleagues found that video-assisted thoracoscopic surgery (VATS) was less likely than open resection to be associated with long-term opioid use in patients undergoing surgery for early-stage lung cancer. Emanuela Taioli, MD, PhD, of the Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, is the corresponding author for the JAMA Oncology article.
Stephanie Tuminello, MPH
Emanuela Taioli, MD, PhD
The study involved Surveillance, Epidemiology, and End Results–Medicare linked data on patients with stage I primary non–small cell lung cancer who had VATS or open resection between January 2007 and December 2013. Patients with an opioid prescribed in the 30 days before surgery were excluded from analysis. Long-term opioid use was defined as having filled at least 1 prescription in the first 90 days after surgery and another prescription 90 to 180 days after surgery. Associations between surgery type and long-term opioid use were assessed by multivariable logistic regression and propensity score matching analysis.
Long-Term Opioid Use
Among 3,900 patients included in the analysis, 1,987 (50.9%) underwent VATS and 1,913 (49.1%) underwent open resection. Overall, 2,766 patients (70.9%) were discharged with an opioid prescription and 603 (15.5%) had long-term postoperative use.
Patients who underwent VATS were more likely to be women; to be older; to have a smaller tumor; to have adenocarcinoma; to have a limited resection; to have a lower comorbidity score; to have a higher income quartile; and to live in an urban area. In unadjusted analysis, those undergoing VATS were significantly less likely to have filled an opioid prescription within 90 days after surgery, had a smaller number of overall opioid prescriptions filled, and were less likely to be long-term opioid users vs patients having open resection.
The multivariable model adjusted for type of surgery, age at diagnosis, histology, Charlson co-morbidity score, income, year of diagnosis, prior psychiatric condition, and use of sleep medication within 30 days before surgery, as well as for race/ ethnicity, sex, tumor site, tumor size, extent of resection, urban living environment, marital status, and age by surgery type. In the adjusted model, factors associated with reduced likelihood of long-term opioid use were VATS (adjusted odds ratio [aOR] = 0.69, 95% confidence interval [CI] =0.57–0.84), older age (aOR = 0.96, 95% CI = 0.94–0.98), and higher income (aOR =0.77, 95% CI =0.60–0.99). Factors associated with increased likelihood of long-term use were higher comorbidity score (aOR = 1.10, 95% CI = 1.05–1.16), large-cell histology (aOR = 1.88, 95% CI = 1.17–3.00), use of sleep medication 30 days before surgery (aOR = 1.72, 95% CI = 1.28–2.32), and previous psychiatric condition (aOR = 1.64, 95% CI = 1.28–2.09). Propensity score matching analysis also showed that VATS was associated with reduced likelihood of long-term use vs open resection (aOR = 0.52, 95% CI = 0.36–0.75).
The investigators concluded, “Our study suggests that surgical invasiveness might play a role in the odds [long-term opioid use] after surgery; patients undergoing VATS were less likely to use opioids both in the immediate postoperative period and long-term, even after adjusting for relevant covariates.”