ArticleBMJ (Clinical research ed.)2014
Rates and risk factors for prolonged opioid use after major surgery: population based cohort study.
Article in BMJ (Clinical research ed.), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 10 registered trials, which are not on this map. Cited by 368 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Prevalence and Predictors of Prolonged Post-surgical Opioid Use: a Prospective Observational Cohort Study
Cognitive Flexibility Training in Persistent Pain
Ontario Transitional Pain and Opioid Safety Program: Improving Pain and Opioid Practices for Complex Chronic Pain Patients Following Surgery
Cognitive Flexibility Training for Persistent Pain: Neuroimaging Pilot (COFLEX-i)
Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Alleviation in Perioperative Fracture Patients
The Postoperative Opioid-Sparing Effect of an Intraoperative Pecto-Intercostal Fascial Block and Opioid-Free Anesthesia in Cardiac Surgery Patients: a Prospective Randomized Controlled Trial
Optimization of Post-Operative Pain Following Orthognathic Surgery With Personalized Opioid Prescription and Tapering Protocols
A Randomized, Controlled, Observer-blinded Pilot Trial of Laparoscopic Large Volume, Multisite Transversus Abdominal Plane (TAP) Block With Liposomal Bupivacaine in Patients Undergoing Minimally Invasive Hysterectomy for Endometrial Cancer
Advancing Online Psychology Tools for the Transitional Pain Service (ADOPT-TPS): Pilot Feasibility and Efficacy Randomized-Controlled Trial of a Scalable, Online Psychology Intervention for Post-Surgical Pain and Opioid Use
Clinical Evaluation of an External Neuromodulation Device (VibraCool) to Reduce Pain and Opioid Use After Anterior Cruciate Ligament Reconstruction (ACLR)
Who cites it
368 citing papers in PubMed, 2 syntheses or guidelines pooled it, 924 citations in OpenAlex.
- Effect of dexmedetomidine supplementation for thoracoscopic surgery: a meta-analysis of randomized controlled trials.Journal of cardiothoracic surgery · 2022Pooled it
- Systematic Review and Meta-Analysis of the Association Between Non-Steroidal Anti-Inflammatory Drugs and Operative Bleeding in the Perioperative Period.Journal of the American College of Surgeons · 2021Pooled it
- Integrating Nonpharmacological Options Into Perioperative Pain Care: A Cluster Randomized Clinical Trial.JAMA network open · 2026Trial
- Gabapentin as an adjunct to multimodal pain regimens in surgical patients: the GAP placebo-controlled RCT and economic evaluation.Health technology assessment (Winchester, England) · 2026Trial
- Comparison between butorphanol and nalbuphine for alleviation of catheter-related bladder discomfort and emergence agitation in patients undergoing open spinal surgery: a randomized clinical trial.Annals of medicine · 2025Trial
- Patients' Perception of a Brief Web- and Mindfulness-Based Intervention for Pain Following Discharge After Total Joint Arthroplasty: Qualitative Description.JMIR nursing · 2025Trial
- Trial
- Analgesic and Hemodynamic Effects of Dexmedetomidine-Ketamine vs Fentanyl-Ketamine in Healthy Volunteers: A Randomized Trial.Journal of pain research · 2025Trial
- Effect of oxycodone versus fentanyl for patient-controlled intravenous analgesia after laparoscopic hysteromyomectomy: a single-blind, randomized controlled trial.Scientific reports · 2024Trial
- A Randomized Controlled Trial of Clinical Hypnosis as an Opioid-Sparing Adjunct Treatment for Pain Relief in Adults Undergoing Major Oncologic Surgery.Journal of pain research · 2024Trial
- Noninvasive Bioelectronic Treatment of Postcesarean Pain: A Randomized Clinical Trial.JAMA network open · 2023Trial
- Comparison of the Analgesic Efficacy of Opioid-Sparing Multimodal Analgesia and Morphine-Based Patient-Controlled Analgesia in Minimally Invasive Surgery for Colorectal Cancer.World journal of surgery · 2022Trial
- Brain-based measures of nociception during general anesthesia with remifentanil: A randomized controlled trial.PLoS medicine · 2022Trial
- Utilization and evolving prescribing practice of opioid and non-opioid analgesics in patients undergoing lymphadenectomy for cutaneous malignancy.Journal of surgical oncology · 2022Trial
- The incidence of persistent postoperative opioid use among U.S. veterans: A national study to identify risk factors.Journal of clinical anesthesia · 2021Trial
- Effect of dexmedetomidine on intraoperative Surgical Pleth Index in patients undergoing video-assisted thoracoscopic lung lobectomy.Journal of cardiothoracic surgery · 2020Trial
- Opioid-sparing and opioid-free anaesthesia: concepts, rationale, evidence, and practical implications.Anaesthesiology intensive therapy · 2026Review
- The transitional pain service: a narrative review on the approach to managing chronic post-surgical pain.Journal of anesthesia · 2026Review
- Use of Electronic Patient Record Systems for Rapid Response to an MHRA Public Assessment Report: Retrospective Observational Study.JMIR formative research · 2026Observational
- Article
308 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
5 authors at 4 institutions in 1 country.
Funding
Abstract
objectiveTo describe rates and risk factors for prolonged postoperative use of opioids in patients who had not previously used opioids and undergoing major elective surgery.
designPopulation based retrospective cohort study.
settingAcute care hospitals in Ontario, Canada, between 1 April 2003 and 31 March 2010.
participants39,140 opioid naïve patients aged 66 years or older who had major elective surgery, including cardiac, intrathoracic, intra-abdominal, and pelvic procedures.
main outcome measureProlonged opioid use after discharge, as defined by ongoing outpatient prescriptions for opioids for more than 90 days after surgery.
resultsOf the 39,140 patients in the entire cohort, 49.2% (n=19,256) were discharged from hospital with an opioid prescription, and 3.1% (n=1229) continued to receive opioids for more than 90 days after surgery. Following risk adjustment with multivariable logistic regression modelling, patient related factors associated with significantly higher risks of prolonged opioid use included younger age, lower household income, specific comorbidities (diabetes, heart failure, pulmonary disease), and use of specific drugs preoperatively (benzodiazepines, selective serotonin reuptake inhibitors, angiotensin converting enzyme inhibitors). The type of surgical procedure was also highly associated with prolonged opioid use. Compared with open radical prostatectomies, both open and minimally invasive thoracic procedures were associated with significantly higher risks (odds ratio 2.58, 95% confidence interval 2.03 to 3.28 and 1.95 1.36 to 2.78, respectively). Conversely, open and minimally invasive major gynaecological procedures were associated with significantly lower risks (0.73, 0.55 to 0.98 and 0.45, 0.33 to 0.62, respectively).
conclusionsApproximately 3% of previously opioid naïve patients continued to use opioids for more than 90 days after major elective surgery. Specific patient and surgical characteristics were associated with the development of prolonged postoperative use of opioids. Our findings can help better inform understanding about the long term risks of opioid treatment for acute postoperative pain and define patient subgroups that warrant interventions to prevent progression to prolonged postoperative opioid use.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.