NSCLC: VATS tied to less opioid use than open surgery

  • JAMA Oncol

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Patients who undergo video-assisted thoracoscopic surgery (VATS) for stage I NSCLC are significantly less likely than open surgery patients to use opioids immediately after surgery and over the long term.

Why this matters

  • Pain is common after early-stage lung cancer surgery, and this study suggests surgical invasiveness might increase the risk for long-term opioid dependence.

Study design

  • 3900 opioid-naive patients with stage 1 NSCLC from the Surveillance, Epidemiology, and End Results database underwent VATS (n=1987) or open surgery (n=1913) during 2007-2013.
  • Funding: National Cancer Institute.

Key results

  • 70.9% of patients were discharged with an opioid prescription.
  • 15.5% had a record of long-term postoperative use.
  • Compared with open surgery patients, the VATS group was significantly less likely to use short-term opioids (74.5% vs 67.6%; P<.001 and long-term opioids vs p filled fewer opioid prescriptions within days of surgery>
  • Patients who underwent VATS were significantly less likely to use opioids long term after multivariable analysis (aOR, 0.69; 95% CI, 0.57-0.84) and propensity matching (aOR, 0.52; 95% CI, 0.36-0.75).

Limitations

  • The data do not reflect the possibility of patients securing opioids without a prescription.

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