Diabetes Boosts Postoperative Opioid Use

Mitchel L. Zoler, PhD, for Medscape

December 06, 2022

Researchers published the study covered in this summary on Preprints With The Lancet as a preprint that has not yet been peer reviewed.

Key Takeaways

  • People with diabetes who underwent surgery had a significantly increased rate of prolonged opioid use (POU) compared to people without diabetes who underwent surgery in a retrospective, observational study of more than 43,000 people who had operations at a single diverse healthcare system in 2008-2019.  

  • People with type 2 diabetes had an adjusted, significant 56% higher rate of prolonged opioid use compared to those without diabetes. The rate was even higher in those with type 1 diabetes, who had an adjusted rate that was a significant 2.63-fold higher compared to people without diabetes.

  • The results showed no difference in discharge opioid morphine milligram equivalents between patients with and without diabetes even though patients with diabetes presented with known pain risk factors, including higher rates of previous opioid use, depression, and preoperative pain scores.

Why This Matters

  • The findings provide population-level, real-world data that may guide future opioid prescribing and precision-medicine approaches for people with diabetes who undergo surgery to improve the outcomes of these patients.

  • The results show that in a real-world setting healthcare providers are generally not accounting for individual risk factors when prescribing postoperative opioids.

Study Design

  • A retrospective study of observational data collected via electronic health records of adults 18-89 years old who underwent surgery in 2008-2019 and were prescribed an opioid for postoperative pain management at a diverse healthcare center located in Northern California that included an academic medical center, a community hospital, and primary and specialty care alliance.

  • The review excluded patients hospitalized for more than 13 days to limit those with postsurgical complications. The study also excluded patients who faced an external event or competing risk for opioid use independent of postoperative pain management, those who did not receive at least one opioid prescription following surgery, and patients seen once for a one-off surgery that made study of their postoperative pain course impossible.

  • The primary outcome was prolonged opioid use, defined as a new opioid prescription starting 3-6 months after surgical discharge.

Key Results

  • The total cohort of 43,654 surgical patients included 5417 (12.4%) people with diabetes, including 291 (5%) with type 1 diabetes and 5126 (95%) with type 2 diabetes.

  • Patients with diabetes had a significantly higher rate of prolonged opioid use following surgery, at 17.7%, compared to patients without diabetes, 12.7%, an unadjusted relative increase of 39%.

  • Patients with type 1 diabetes had a 24.4% incidence of prolonged opioid use compared to 17.3% among patients with type 2 diabetes.

  • After adjustment for all collected demographic and clinical variables, people with type 1 diabetes had a significant 2.63-fold higher incidence of prolonged opioid use compared to patients without diabetes. Those with type 2 diabetes had a 1.56-fold increased incidence of prolonged opioid use compared to those without diabetes.


  • The study focused on patients from Northern California, and so may not be generalizable to patients who live elsewhere.

  • Data on opioid use may not have been complete.

  • This was a retrospective, observational study, and so may involve the influence of unmeasured confounding factors.

  • Documentation of diabetes relied on diagnostic codes in each patient's record, and for some patients, these records may not have been complete.         


  • The study received no commercial funding.

  • None of the authors had disclosures.

This is a summary of a preprint research study, "Postoperative Opioid Prescribing in Diabetics: Opportunities for personalized pain management," written by researchers at Stanford University, published on Preprints With The Lancet, and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found here.


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