Exploring incidence and risk factors for persistent postoperative opioid use in adult surgical patients: a systematic review protocol.

Abstract

The objective of this review is to determine the incidence of persistent postsurgical use of opioids in adult patients and the associated risk factors. Surgery has been identified as an independent risk factor for unwarranted chronic opioid use, contributing to opioid-related harm in the community. Persistent opioid use after surgery is associated with morbidity and mortality from opioid-related adverse events, indicating a significant yet mitigable public health concern. There is substantial variation in the reported incidence and risk factors for postoperative opioid use, which require evaluation for future evidence-based risk-reduction strategies. This review will include studies investigating the persistent use of opioids after 90 postoperative days in adult (≥18y) patients undergoing surgery of any type, including cancer pain patients. Selected evidence must report on opioid use prior to surgery. Analytical and descriptive observational studies, and experimental and quasi-experimental studies, published in the last decade will be eligible for inclusion. The proposed study methods follow the JBI methodology for systematic reviews of prevalence and incidence. A systematic search will be conducted in PubMed, Embase, CINAHL, Cochrane Central, Web of Science, and a search of gray literature will include Google Scholar and ClinicalTrials.gov. Study selection, critical appraisal, and data extraction will be performed by 2 independent reviewers aided by the relevant JBI systematic review tools. We aim to produce a narrative synthesis of results and conduct a meta-analysis where feasible, in addition to subgroup analyses of suitable populations. The results are intended to promote safe, evidence-based postoperative opioid prescribing when considering risk factors for persistent postoperative opioid use.