The Risks of Opioid Use After Eye Surgery

Many patients have their first exposure to opioids following surgery, when they are given prescriptions to manage postoperative pain. The risk that patients will develop issues with chronic opioid use has been documented in numerous surgical specialties. But until recently, the risk after eye surgery has not been described.

To document patterns of opioid prescription and usage as well as risk factors in ophthalmic surgery, a study team led by Kellogg surgeon and researcher Maria Woodward, M.D., M.S., conducted a retrospective cohort analysis based on private insurance claims. The results were published in the September 2021 issue of the journal Ophthalmology.

The dataset included information on 327,379 opioid-naïve patients who underwent ophthalmic surgery. The most common surgeries performed were anterior segment, oculoplastic and retinal procedures.

Of the 4.5 percent of patients who filled an initial perioperative opioid prescription, 3.4% developed new persistent opioid use (defined as use beyond the 90-day postoperative recovery period). Within that group, a prescription size of 150 morphine milligram equivalents or more was associated with an increased chance of refilling.

Among the 95.4% of patients who did not fill an initial prescription after surgery, the rate of persistent opioid use was 0.6 percent."

Our analysis establishes that exposure to opioids after incisional ophthalmic surgery is an independent risk factor for new chronic use in patients who were previously opioid naive ” explains Dr. Woodward.

The study also took into account additional patient-level risk factors, including a number of pre-existing health conditions and sociodemographic variables. “We observed that those who face a greater likelihood of persistent opioid use include women, people of Black race, residents of southern states, those with lower household incomes, and tobacco users,” she says.

“Like all surgeons, eye surgeons need to be mindful of the overall risks of prescribing opioids and the factors that elevate risk in certain patients,” notes Dr. Woodward. “We need to have frank conversations with our patients about pain, medications and expectations, and deemphasize opioid use whenever possible.”

Dr. Woodward, a member of the American Academy of Ophthalmology’s Opioid Task Force, collaborated with several U-M clinical and health services researchers on this study, including members of the Michigan Opioid Prescribing Engagement Network (M-OPEN), which is addressing the opioid crisis through novel research and evidence-based actions