Medicare beneficiaries who take considerable amounts of opioid painkillers prior to outpatient surgery are more likely to die within 90 days following the procedure, according to new research. 

The findings highlight the need to address preoperative opioid exposure to ensure a safe postoperative recovery, wrote study lead Katherine Santosa, M.D., of the University of Michigan. 

Patients who use opioids preoperatively may build up a tolerance and require higher doses for postoperative pain control, she and her colleagues said. 

“They may also be more vulnerable to opioid-related adverse events, such as respiratory complications, readmissions, and mortality,” they wrote.

The study team followed mortality outcomes in nearly 100,000 participants. Pre-surgical opioid use was classified by pharmaceutical fills in the year prior to surgery. The researchers also accounted for factors including dose, duration, proximity to surgical date, and continuity of fills.

Participants in the highest preoperative opioid exposure group were more likely to die within 90 days after outpatient surgery compared with opioid-naive patients, even after researchers controlled for type of surgery. Medium-exposure preoperative opioid users also had higher rates of 90-day mortality compared with patients who did not use opioids. 

Notably, there was no difference in mortality between patients who did not use opioids and patients with low preoperative opioid exposure. 

The study was published in JAMA Surgery.