Outpatient opioid use after minimally invasive surgery for lung cancer: a Surveillance, Epidemiology, and End Results-Medicare cohort study.

Background: Opioids are commonly used for postoperative pain after lung resection. It is unclear whether opioid use differs between minimally invasive thoracoscopic approaches. We compared opioid use following robotic-assisted surgery (RAS) and video-assisted thoracoscopic surgery (VATS). Methods: The Surveillance, Epidemiology, and End Results-Medicare claims database was queried for patients who underwent resection of non-small cell lung cancer (NSCLC) between January 2016 and July 2020. Outcomes included any opioid, abuse-potential (schedule II/III), and high-dose (≥50 morphine milligram equivalents/day) opioid fill, assessed across immediate (0-42 days), short-term (43-90 days), and long-term (91-180 days) periods. Inverse-probability of treatment weighted logistic regression was used to compare RAS and VATS. Results: A total of 4,243 eligible patients (1,157 RAS vs. 3,086 VATS) were examined. In the immediate period, RAS had a similar rate of any opioid fill to VATS (70% vs. 71%, P=0.40), but RAS was associated with less likelihood of fill for abuse-potential [odds ratio (OR) =0.85; P=0.02], and high-dose opioids (OR =0.76; P=0.006). In the short-term period, RAS was associated with less likely opioid fills than VATS (any opioid: OR =0.76, P=0.02; abuse-potential: OR =0.65, P=0.002; high-dose: OR =0.46, P=0.03). There was no difference in long-term opioid fills, except among adjuvant therapy subgroup where RAS was associated with less likely fill for any opioid (OR =0.70; P=0.047) and abuse-potential opioids (OR =0.58; P=0.007). Conclusions: RAS was associated with reduced short-term opioid use compared to VATS after NSCLC resection.