Trends and Patterns of Postoperative Opioid Exposure Among Surgical Patients After the 2016 Center for Disease Control Guideline for Prescribing Opioids.

INTRODUCTION

Perioperative opioid exposure remains a public health concern because short-term postoperative prescribing may be associated with persistent opioid use and downstream substance-related harms. We examined postoperative opioid exposure, persistent opioid use, and substance use disorder (SUD) diagnoses among opioid-naive surgical patients before and after the 2016 Center for Disease Control and Prevention (CDC) opioid-prescribing guideline.

METHODS

Electronic health record data from the All of Us Research Program were used to identify opioid-naive adults undergoing qualifying surgical procedures from 1983 to 2023. Acute opioid-related events were defined as opioid-related safety or documentation signals within 30 d of surgery, including naloxone or naltrexone administration or opioid-related diagnoses. Persistent postoperative opioid use was defined as recurrent opioid exposure during postoperative days 31-180 among patients without opioid exposure in the prior year. Long-term SUD was defined as a new diagnosis of opioid, alcohol, nonopioid drug, or polysubstance use disorder after the early postoperative period and within 5 y.

RESULTS

Among 13,240 opioid-naive surgical patients, 5748 (43.4%) had documented opioid exposure within 30 d of surgery. Acute opioid-related events occurred in 674 patients (5.1%). Persistent opioid use occurred in 116 patients (0.9% overall; 2.0% among those with 30-d opioid exposure). Any SUD diagnosis within 5 y occurred in 790 patients (6.0%). In adjusted models, each additional day of opioid supply within postoperative days 0-30 was associated with higher odds of persistent opioid use (adjusted odds ratio 1.04 per day, 95% confidence interval 1.03-1.04) and 5-y SUD (adjusted odds ratio 1.01 per day, 95% confidence interval 1.01-1.02). Total morphine milligram equivalent (MME) dose was associated with persistent opioid use but not independently associated with 5-y SUD. Interrupted time series analysis demonstrated a reduction in mean postoperative MME immediately after the 2016 CDC guideline and a negative postguideline slope change in persistent opioid use and 5-y SUD rates.

CONCLUSIONS

Among opioid-naive surgical patients, longer postoperative opioid duration was associated with persistent opioid use and subsequent SUD diagnoses. The 2016 CDC guideline was temporally associated with lower postoperative MME and changing opioid-related outcome trends, although causal attribution cannot be inferred from this retrospective observational design.