Association of Prescription Opioid Exposure and Patient Factors With Prolonged Postoperative Opioid Use in Opioid-Naïve Patients.

The purpose of this research study was to identify factors associated with prolonged postoperative opioid use in opioid-naïve patients in 2 domains: specific patient characteristics and exposure through postoperative opioid prescriptions. A retrospective analysis was conducted of electronic medical records of opioid-naïve adult orthopedic surgical patients at a large academic medical center from January 1, 2012, through December 31, 2017. In this cohort, 4% continued to refill opioid prescriptions more than 90 days after their surgical procedure. Prolonged use was associated with an initial prescription that had an oral morphine milligram equivalent above 675. Receipt of opioid prescription refills was a significant predictor for receiving additional opioid prescriptions over time. Multivariate logistic regression indicated that the independent predictors of prolonged postoperative opioid use were alcohol abuse, black race, Medicaid insurance, and the following comorbidities: diabetes, mood disorder, hypertension, and chronic kidney disease. To decrease the rate of prolonged postoperative opioid use, clinical changes can be investigated, including collaborative perioperative pain management strategies using nonopioid pain control methods; perioperative patient screening; education of patients and clinicians; and close postoperative follow-up, especially in the most vulnerable populations. Copyright© by the American Association of Nurse Anesthetists.