Preoperative factors predict persistent opioid use after surgery

For many Americans, a routine surgical procedure serves as their first introduction to opioid pain medication. While most stop using these drugs as they heal, a considerable number of "opioid-naïve" patients transition into New Persistent Opioid Use (NPOU)-continuing use long after the typical recovery period.

A new systematic review and meta-analysis led by Penn Nursing researchers, published in Pain Medicine, has identified the specific patient-related risk factors that most accurately predict which individuals are at the highest risk for this dangerous transition. The study, which synthesized data from 27 high-quality studies, found that four primary factors significantly increase the odds of a patient becoming a long-term opioid user following surgery: Medicaid enrollment, preoperative benzodiazepine use, mood disorders, and anxiety.

Identifying who is at risk before the first incision is made is a critical step in combatting the opioid crisis. Our findings provide a roadmap for clinicians to implement targeted interventions, ensuring that high-risk patients receive enhanced monitoring and alternative pain management strategies."

Yoonjae Lee, DNP, APRN, lead author and doctoral student 

The risk factor breakdown

Through a rigorous meta-analysis, the research team derived "pooled odds ratios," which quantify how much each factor is associated with the odds of persistent use:

• Medicaid Enrollment & Preoperative Benzodiazepines: These were the strongest predictors, with patients in these categories having 77% higher odds of developing NPOU (Odds ratio: 1.77).
• Mood Disorders: Patients with a history of depression or other mood disorders faced 24% higher odds compared to those without.
• Anxiety: Patients with pre-existing anxiety disorders had 17% greater odds of persistent use.

A call for holistic preoperative screening

NPOU is defined as continued opioid use beyond three months post-surgery and has been linked to increased morbidity, higher mortality rates, and long-term complications.

The study's findings emphasize that "opioid-naïve" status, meaning the patient has not used opioids recently, is not a standalone guarantee of safety. By highlighting that social determinants (such as insurance type) and psychological factors (such as anxiety) are just as influential as the surgery itself, the researchers advocate for a more comprehensive approach to preoperative screening. Integrating these data-driven insights into clinical practice can help prevent the unintended consequences of surgical pain management and improve long-term outcomes for patients nationwide. Co-authors for this study include Rosemary C. Polomano; Heath D. Schmidt, PhD; Jungwon Min, PhD; and Peggy A. Compton, PhD; all of Penn Nursing.