Influence of Surgical Options for Early-Stage Lung Cancer on Opioid Use

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Researchers employed multivariate logistic regression analysis to ascertain any association between surgery method and long-term opioid use.
Researchers employed multivariate logistic regression analysis to ascertain any association between surgery method and long-term opioid use.

Pain following surgery for early-stage lung cancer can be extensive, but whether a minimally invasive surgery option such as video-assisted thoracoscopic surgery (VATS) can limit the need for opioids for pain control was examined in a study published in JAMA Oncology.1

The study authors analyzed Surveillance, Epidemiology, and End Results (SEER) data from January 1, 2007, to December 31, 2013, involving patients with Medicare Part D who underwent either open resection (n=1913) or VATS (n=1987) for stage 1 primary non-small cell lung cancer.

The researchers performed multivariate logistic regression analysis to ascertain any association between surgery method and long-term opioid use, defined as at least one prescription filled within 90 days of surgery and at least one prescription filled between 90 and 180 days after surgery.

Following surgery, 70.9% of all patients received opioid prescriptions upon discharge, with 15.5% showing long-term use. Short-term opioid use was slightly less common with VATS than with open resection (67.6% of patients vs 74.5%, respectively; P <.001), and long-term opioid use was also less common with VATS than with open resection (11.9% vs 19.1% of patients, respectively; P <.001).

The propensity-matched odds ratio of long-term opioid use with VATS vs open resection was 0.52 (95% CI, 0.36-0.75), indicating VATS was less associated with long-term opioid use than open resection was.

The authors noted that they were unable to assess whether patients obtained opioids from sources outside of prescriptions found in patient records. However, these study results suggest VATS may result in less short- and long-term opioid use than open resection in patients treated for early-stage lung cancer.

Reference

Tuminello S, Schwartz RM, Liu B, et al. Opioid use after open resection or video-assisted thoracoscopic surgery for early-stage lung cancer [published online September 24, 2018]. JAMA Oncol. doi: 10.1001/jamaoncol.2018.4387 

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