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Doesn’t matter which medical center or what diagnosis is studied: approximately 20% of patients undergoing surgery do not respond even with a technically well done surgery. Preoperative opioid usage is one of the main modifiable risk factors that contribute to poor outcome (others include uncontrolled diabetes, obesity, psychiatric disorders).

In a recent study of preoperative opioid usage, the authors showed that patients who suffer from depression and anxiety have a much higher need for narcotics. In addition, patients using more narcotics were more likely to be depressed and anxious.

Additionally, patients with essentially identical conditions with identical, technically well-done surgeries, had much worse outcomes at 12 months after surgery if they were using opioids pre-operatively!

Regarding the eventual goal of being opioid independent, if patients were on preoperative opioids, they were less likely to be able to eventually wean off narcotics. Only 41% of patients who used pre-op opioids were able to eventually free themselves of opioid use, where 74% of pre-op non-users were able to achieve opioid independence. 65% of depressed patients continued on narcotics compared to 38% who weren’t depressed. Also, 30% of readmissions are due to inadequate pain control, which was much more common in pre-operative opioid users.

Bottom line is that patients undergoing surgery will likely have a better surgical outcome and are much more likely to be able to eventually completely wean off narcotics if they don’t take opioids preoperatively.