Persistent postoperative opioid use in Europe A systematic review

BACKGROUND In the United States, postoperative opioid prescriptions have been implicated in the so-called 'opioid epidemic'. In Europe, the extent of overprescribing or misuse of opioids is not known. OBJECTIVES To describe the proportion of persistent postoperative opioid use in adults (>18 years) in European countries. DESIGN Systematic review of the published data. DATA SOURCES We searched the electronic literature databases MEDLINE (Ovid), Embase (Ovid), PubMed/MEDLINE and Scopus. ELIGIBILITY CRITERIA Studies describing opioid use in adult patients (>18 years) at least 3 months after surgery. RESULTS One thousand three hundred and seven studies were found, and 12 studies were included in this review. The rate of opioid use after 3 to 6 months was extracted from the studies and categorised by the type of surgery. Nine studies investigated opioid use after total hip or total knee arthroplasties (THA and TKA) and reported opioid user rates between 7.9 and 41% after 3 months. In all the included studies, a proportion between 2 and 41% of patients were opioid users 3 months after surgery. The level of evidence varied from high to very low. CONCLUSION To describe persistent opioid use in relation to specific countries or types of surgery is not possible. Because of the wide ranges observed, we can neither confirm nor rule out a possible public health problem linked to the persistent use of opioids in Europe. STUDY REGISTRATION PROSPERO: CRD42019154292.

Automated summary

The proportion of persistent postoperative opioid use in European countries is not well-established, as different studies show varying results. It is not possible to describe persistent opioid use in relation to specific countries or types of surgery due to the wide ranges observed.