Opioid Consumption and Fills after Operation in Adults on High-Dose Prescription Opioids.

Abstract

Preoperative high-dose opioid use complicates perioperative pain management, yet postoperative consumption and refill patterns relative to opioid-naive patients remain poorly defined. We compared 30-day opioid consumption and 90-day prescription fills after common surgical procedures by preoperative opioid exposure. We conducted a retrospective cohort study of adults undergoing operation (January 1, 2019, to May 15, 2022) in the Michigan Surgical Quality Collaborative linked to statewide Prescription Drug Monitoring Program data. Patients were categorized as high-dose (1 day or more with greater than or equal to 30 mg oxycodone equivalents or any extended-release opioid), low dose, or opioid naive. The primary endpoint was 30-day patient-reported opioid consumption (oxycodone 5 mg equivalents). Secondary outcomes included 90-day postoperative fills. Adjusted zero-inflated negative binomial models with clustered robust SEs were used. Among 72,616 patients (5,346 high dose; 14,180 low dose; 53,090 opioid naive), adjusted mean 30-day consumption was 4.6 pills (95% CI 4.3 to 4.9) for high-dose patients, 3.9 (3.8 to 4.1) for low-dose, and 3.2 (3.1 to 3.3) for opioid-naive patients. The 75th percentile consumption was 7.9, 6.7, and 5 pills, respectively. In contrast, 90-day fills were substantially more frequent among high-dose patients (48.3%) compared with low-dose patients (27.1%) and opioid-naive patients (8.2%). At the 75th percentile, the total 90-day fill size was 360 pills for high-dose patients vs 92 and 24 pills, respectively. Among high-dose patients, mean daily postoperative opioid use was similar to or lower than preoperative levels. Patients with high-dose preoperative opioid exposure report clinically similar 30-day postoperative consumption as opioid-naive patients but experience substantially greater 90-day prescription refills, generally without escalation beyond baseline dosing. Perioperative planning should emphasize coordination with usual prescribers to prevent fragmented, prolonged opioid use.