Opioid use disorder doubles the odds of postoperative respiratory events

Design

Systematic review and meta-analysis of observational studies

Population

Adults with and without opioid use disorder undergoing surgery, 40 studies

Primary outcome

Postoperative pain and composite respiratory complications

Effect

Pain OR 2.87 (95% CI 1.63 to 5.06); respiratory OR 2.10 (1.64 to 2.68)

A systematic review and meta-analysis in Anaesthesia pooled 40 studies comparing adults with and without opioid use disorder having surgery.

People with opioid use disorder had higher odds of postoperative pain (OR 2.87, 95% CI 1.63 to 5.06; three studies) and of composite respiratory complications (OR 2.10, 1.64 to 2.68; 19 studies), both rated moderate certainty. Pneumonia and pulmonary embolism were among the complications that were more common. Low-certainty evidence linked the disorder to more readmissions, longer stays and higher costs. In-hospital mortality did not differ significantly, on very low-certainty evidence.

These are observational associations and opioid use disorder travels with smoking, other substance use and social disadvantage, so the disorder itself may not be the cause. The practical point holds regardless: these patients are a higher-risk group, and identifying them before surgery allows a plan for analgesia, continuation of opioid agonist treatment, and respiratory monitoring.

• Ask about opioid use and any opioid agonist treatment at every pre-operative assessment.
• Continue methadone or buprenorphine through the perioperative period unless there is a specific reason not to, and plan analgesia around it.
• Use multimodal and regional analgesia to limit additional opioid needs.
• Consider enhanced respiratory monitoring after surgery for patients with opioid use disorder.
• Involve addiction or pain services early for complex patients.

Why it matters

A group already at higher risk of pain and respiratory harm often reaches theatre without a plan.

Don't overread it

These observational associations do not show that opioid use disorder itself causes the complications.

The statistics, in plain English

An odds ratio of 2.10 means the odds of a respiratory complication were about twice as high. The pain estimate rests on only three studies, so its wide interval reflects real uncertainty.

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