Systematic review on postoperative opioid use and other outcomes after lobectomy for lung cancer in the U.S.

OBJECTIVE

This systematic review summarizes literature on postoperative opioid use in lung cancer patients after lobectomy, focusing on opioid consumption, survival, recurrence, pain scores, length of stay, readmission, and in-hospital mortality.

METHODS

PubMed and Embase were searched from 1 January 1993, to 31 May 2024, for observational studies on U.S. lung cancer patients. Retrospective studies reporting the outcomes of interest were included, excluding pediatric populations, non-English publications, non-lung cancer studies, reviews, meta-analyses, economic modeling papers, or interventional studies.

RESULTS

Out of 683 identified articles, 22 studies met inclusion criteria, encompassing 77,315 patients. Commonly used opioids were morphine, hydromorphone, and fentanyl. Pain scores varied by surgical approach, with better control reported with video-assisted thoracoscopic surgery (VATS) and liposomal bupivacaine (LB). Longer hospital stays were linked to higher odds of persistent opioid use. Higher opioid doses were associated with decreased overall survival (OS) and recurrence-free survival.

CONCLUSIONS

The review highlights the complex relationship between postoperative opioid use and outcomes in lung cancer patients post-lobectomy. Alternatives like intercostal nerve blocks with LB and VATS can reduce opioid use and enhance recovery, emphasizing personalized pain management. Future research should focus on reducing opioid overprescription and patient education to minimize long-term use.