Risk of Chronic Opioid Use in Opioid-Naive and Non-Naive Patients after Ambulatory Surgery

Background Chronic postoperative opioid use has been demonstrated after surgery, but there is a paucity of data on whether the amount of opioids given at discharge is a significant contributor to the risk of prolonged use. The purpose of this study was to determine if higher amounts of opioids prescribed after ambulatory surgery increases chronic opioid use in opioid-naive and non-naive patients. Methods Using the Institutional Data Warehouse, 15,220 adult patients were identified who underwent ambulatory elective surgeries at our institution between January 2014 and July 2018 and received a perioperative opioid prescription. Multivariate logistic regression was used to characterize the relationship between amount of perioperative opioids prescribed and chronic opioid use. Results The study population consisted of 14,378 (94%) opioid-naive and 842 (6%) non-naive patients. Seven hundred fifty-seven (5%) patients received a new opioid prescription 90 to 365 days after surgery. Patients that had a lower amount of total perioperative opioids (0-150MMEs, 151-300MMEs, or 301-450MMEs) had 44-54% lower risk of persistent opioid use after surgery compared to those who received > 450 MMEs or > 60 pills of 5 mg oxycodone (p < 0.0001). This relationship was especially prominent on subset analysis of opioid non-naive patients, a group that has thus far been left out of opioid-related studies. Conclusion Persistent opioid use is a known complication after surgery. A higher number of opioid pills on discharge after ambulatory surgery is associated with increased risk of chronic opioid use. Surgeons should consider limiting the number of opioid pills prescribed after ambulatory surgery for both opioid-naive and non-naive patients.