Opioid use disorder was linked to double the odds of respiratory complications after surgery

Design

Systematic review and meta-analysis of 40 observational studies

Population

Adults having surgery, with and without opioid use disorder

Primary outcome

Postoperative pain and composite respiratory complications

Effect

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

A systematic review and meta-analysis pooled 40 studies comparing adults with and without opioid use disorder having surgery. The co-primary outcomes were postoperative pain and a composite of respiratory complications.

People with opioid use disorder had nearly three times the odds of postoperative pain, though only three studies reported it, and about twice the odds of respiratory complications, with moderate certainty. Pneumonia and pulmonary embolism were among the complications more common in this group. Lower-certainty evidence linked the disorder to more readmissions, longer stays and higher costs; in-hospital mortality did not clearly differ.

These are observational associations. People with opioid use disorder differ in smoking, other substance use, social circumstances and access to care, all of which could contribute.

The practical message is identification and planning: knowing about opioid use disorder before surgery allows maintenance therapy to continue, a multimodal analgesia plan to be made, and closer respiratory monitoring afterwards.

• Ask about opioid use and opioid use disorder at pre-operative assessment.
• Continue maintenance buprenorphine or methadone unless there is a specific reason not to.
• Plan multimodal and regional analgesia in advance for these patients.
• Consider closer postoperative respiratory monitoring, particularly with added opioids.
• Involve the acute pain or addiction team before discharge.

Why it matters

A diagnosis often missed at pre-assessment marks patients at clearly higher postoperative risk.

Don't overread it

Observational data; the disorder may mark other risks rather than cause the complications.

The statistics, in plain English

An odds ratio of 2.10 for respiratory complications means the odds were about twice as high; its interval (1.64 to 2.68) is reasonably narrow. The pain estimate rests on only three studies, so it is less reliable.

Read the rest in the app

You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.

Get Daily Doctor — free

Scan to keep reading on your phone. No account needed to start.