Postdischarge opioid use and persistent use after general surgery: A retrospective study

Published:April 03, 2022DOI:



      Opioid overprescribing after surgery is a significant public health issue in most developed countries, including New Zealand. However, there is a lack of literature on the patterns and risk factors for postoperative opioid use among general surgical patients in New Zealand. This study aimed to examine opioid use in patients undergoing general surgery at Auckland District Health Board between January and December 2019 and to identify factors associated with opioid use after surgery and persistent opioid use (defined as having filled ≥1 opioid prescription in the 91 to 180 days after surgery).

      Methods and Materials

      This is a retrospective cohort study. Data from patients’ electronic clinical records and community pharmacy dispensing records were extracted to obtain data on sociodemographics, surgical characteristics, comorbidities, co-prescribed medications, and opioid use.


      A total of 1,110 patients were included in the study, with 42.4% dispensed an opioid following discharge after surgery. Of opioid-naïve patients who filled opioids after surgery (n = 401), 9.5% became persistent opioid users. Preoperative use of nonopioid analgesics, longer hospital stays, higher operation severity, procedure type, and higher pain scores were positively associated with opioid use, whereas older age was a negative predictor. Longer hospital stays, an initial discharge prescription with high opioid load, and female sex increased the risk of persistent opioid use. Conversely, a higher severity of surgery was associated with lower risk of persistent opioid use.


      The findings suggest that a considerable proportion of patients become persistent opioid users after surgery. The risk factors identified can guide clinicians to prescribe in a manner that reduces opioid-related adverse outcomes and help guide future interventions.
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        • World Health Organization
        Opioid overdose.
        • Wilson N.
        • Kariisa M.
        • Seth P.
        • Smith H IV
        • Davis N.L.
        Drug and opioid-involved overdose deaths: United States, 2017–2018.
        MMWR Morb Mortal Wkly Rep. 2020; 69: 290-297
        • Shipton E.E.
        • Shipton A.J.
        • Williman J.A.
        • Shipton E.A.
        Deaths from opioid overdosing: implications of coroners’ inquest reports 2008–2012 and annual rise in opioid prescription rates: a population-based cohort study.
        Pain Ther. 2017; 6: 203-215
        • Ladha K.S.
        • Neuman M.D.
        • Broms G.
        • et al.
        Opioid prescribing after surgery in the United States, Canada, and Sweden.
        JAMA Netw Open. 2019; 2e1910734
        • Allen M.L.
        • Leslie K.
        • Parker A.V.
        • et al.
        Postsurgical opioid stewardship programs across Australia and New Zealand: current situation and future directions.
        Anaesth Intensive Care. 2019; 47: 548-552
        • Stanley B.
        • Norman A.F.
        • Collins L.J.
        • et al.
        Opioid prescribing in orthopaedic and neurosurgical specialties in a tertiary hospital: a retrospective audit of hospital discharge data.
        ANZ J Surg. 2018; 88: 1187-1192
        • Lawal O.D.
        • Gold J.
        • Murthy A.
        • et al.
        Rate and risk factors associated with prolonged opioid use after surgery: a systematic review and meta-analysis.
        JAMA Netw Open. 2020; 3e207367
        • Fields A.C.
        • Cavallaro P.M.
        • Correll D.J.
        • et al.
        Predictors of prolonged opioid use following colectomy.
        Dis Colon Rectum. 2019; 62: 1117-1123
        • Stark N.
        • Kerr S.
        • Stevens J.
        Prevalence and predictors of persistent postsurgical opioid use: a prospective observational cohort study.
        Anaesth Intensive Care. 2017; 45: 700-706
        • Chou R.
        • Turner J.A.
        • Devine E.B.
        • et al.
        The effectiveness and risks of long-term opioid therapy for chronic pain: a systematic review for a national institutes of health pathways to prevention workshop.
        Ann Intern Med. 2015; 162: 276-286
        • Wilson R.
        • Pryymachenko Y.
        • Audas R.
        • Abbott J.H.
        Long-term opioid medication use before and after joint replacement surgery in New Zealand.
        NZ M J. 2019; 132: 33-47
        • Pryymachenko Y.
        • Wilson R.A.
        • Abbott J.H.
        • Dowsey M.M.
        • Choong P.F.
        Risk factors for chronic opioid use following hip and knee arthroplasty: evidence from New Zealand population data.
        J Arthroplasty. 2020; 35: 3099-3107.e14
        • Brummett C.M.
        • Waljee J.F.
        • Goesling J.
        • et al.
        New persistent opioid use after minor and major surgical procedures in US adults.
        JAMA Surg. 2017; 152e170504
        • Vellucci R.
        • Mediati R.D.
        • Ballerini G.
        Use of opioids for treatment of osteoporotic pain.
        Clin Cases Miner Bone Metab. 2014; 11: 173
        • Nielsen S.
        • Degenhardt L.
        • Hoban B.
        • Gisev N.
        A synthesis of oral morphine equivalents (OME) for opioid utilisation studies.
        Pharmacoepidemiol Drug Saf. 2016; 25: 733-737
        • Campbell C.I.
        • Weisner C.
        • LeResche L.
        • et al.
        Age and gender trends in long-term opioid analgesic use for noncancer pain.
        Am J Public Health. 2010; 100: 2541-2547
        • Atkinson J.
        • Salmond C.
        • Crampton P.
        NZDep2013 index of deprivation.
        Department of Public Health, University of Otago, Wellington2014
        • Pasternak R.L.
        Preanesthesia evaluation of the surgical patient.
        Refresh Courses Anesthesiol. 1996; 24: 205-219
        • Von Elm E.
        • Altman D.G.
        • Egger M.
        • Pocock S.J.
        • Gøtzsche P.C.
        • Vandenbroucke J.P.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Bull World Health Organ. 2007; 85: 867-872
        • Brescia A.A.
        • Harrington C.A.
        • Mazurek A.A.
        • et al.
        Factors associated with new persistent opioid usage after lung resection.
        Ann Thorac Surg. 2019; 107: 363-368
        • Hanson K.T.
        • Thiels C.A.
        • Polites S.F.
        • et al.
        The opioid epidemic in acute care surgery: characteristics of overprescribing following laparoscopic cholecystectomy.
        J Trauma Acute Care Surg. 2018; 85: 62-70
        • Falzone E.
        • Hoffmann C.
        • Keita H.
        Postoperative analgesia in elderly patients.
        Drugs Aging. 2013; 30: 81-90
        • Tharakan T.
        • Jiang S.
        • Fastenberg J.
        • et al.
        Postoperative pain control and opioid usage patterns among patients undergoing thyroidectomy and parathyroidectomy.
        Otolaryngol Head Neck Surg. 2019; 160: 394-401
        • Newhook T.
        • Arvide E.
        • Vreeland T.
        • et al.
        Opioid prescribing patterns after hepatectomy: Opportunities for minimizing variation and dissemination.
        HPB. 2019; 21: S32
        • Lazar D.J.
        • Zaveri S.
        • Khetan P.
        • Nobel T.B.
        • Divino C.M.
        Variations in postoperative opioid prescribing by day of week and duration of hospital stay.
        Surgery. 2021; 169: 929-933
        • Long S.M.
        • Lumley C.J.
        • Zeymo A.
        • Davidson B.J.
        Prescription and usage pattern of opioids after thyroid and parathyroid surgery.
        Otolaryngol Head Neck Surg. 2019; 160: 388-393
        • Namba R.S.
        • Singh A.
        • Paxton E.W.
        • Inacio M.C.
        Patient factors associated with prolonged postoperative opioid use after total knee arthroplasty.
        J Arthroplasty. 2018; 33: 2449-2454
        • Echeverria-Villalobos M.
        • Stoicea N.
        • Todeschini A.B.
        • et al.
        Enhanced recovery after surgery (ERAS): a perspective review of postoperative pain management under ERAS pathways and its role on opioid crisis in the United States.
        Clin J Pain. 2020; 36: 219-226
        • Shah A.
        • Hayes C.J.
        • Martin B.C.
        Factors influencing long-term opioid use among opioid naive patients: an examination of initial prescription characteristics and pain etiologies.
        J Pain. 2017; 18: 1374-1383
        • Unruh A.M.
        Gender variations in clinical pain experience.
        Pain. 1996; 65: 123-167
        • Hurley R.W.
        • Adams M.C.
        Sex, gender, and pain: an overview of a complex field.
        Anesth Analg. 2008; 107: 309-317
        • Wetzel M.
        • Hockenberry J.
        • Raval M.V.
        Interventions for postsurgical opioid prescribing: a systematic review.
        JAMA Surg. 2018; 153: 948-954
        • Burns S.
        • Urman R.
        • Pian R.
        • Coppes O.J.M.
        Reducing new persistent opioid use after surgery: a review of interventions.
        Curr Pain Headache Rep. 2021; 25: 1-5
        • Finley E.P.
        • Garcia A.
        • Rosen K.
        • McGeary D.
        • Pugh M.J.
        • Potter J.S.
        Evaluating the impact of prescription drug monitoring program implementation: a scoping review.
        BMC Health Serv Res. 2017; 17: 1-8