Objective: The purpose of this study was to evaluate the association between discharge opioid supply ( ≤3 days vs ≥7 days) and the development of chronic opioid use in opioid naive post-surgical patients.
Background: Opioids are used as an effective treatment for post-operative management, trauma, or chronic pain, but can be limited by their side effects and undesirable dependence if dosed improperly or lead to recreational misuse. Current literature states that by limiting opioid supply to 3 or fewer days post-operatively after discharge, there are fewer conversions to long term opioid users among opioid naïve patients. Evaluating similar opioid prescribing practices as in the literature may help to inform safer prescribing practices at our institution.
Methods: A single center retrospective study was performed in a large acute care community teaching hospital from January 1, 2024 through December 31, 2025. Patients were identified between January 1, 2024 to December 31, 2024, with follow up Prescription Drug Monitoring Program (PDMP) data collected for up to one year post discharge through December 31, 2025 to track prescription opioid fills. Adults admitted to the hospital who underwent surgery and were opiate naïve (defined as patients who have not filled an opioid prescription in the previous 6 months prior to surgery) were included in the study. Patients were excluded if they had a history of substance abuse, had cancer or chronic pain, had a cardiac, spinal, or oncological related surgery, and if they underwent another surgery within the 1-year study period after the initial surgery. Patients who were discharged with an opioid supply of 3 days or less were compared to patients discharged with an opioid supply of 7 days or more. Chronic opioid use was defined as having filled 10 or more prescriptions or 90 days of continuous use within a 1-year period after surgery. The primary endpoint was the incidence of new, persistent opioid use defined as more than 10 opioid prescription fills or more than 90 days of continuous use. Secondary endpoints included the types of opioids prescribed, inpatient and outpatient MME (daily and total), type of surgery, 3-month, 6-month, and 1 year prescription fill quantities post discharge.
Results: Of the 676 patients screened, a total of 332 patients (281 in comparator group, 51 in study group) met inclusion criteria. Of this population, 229 (69%) were male, the average hospital length of stay was 3.31 days, the average opioid supply in days on discharge was 7.02, average morphine milligram equivalent (MME) for discharge opioid supply was 35.56. The most prescribed opioid on discharge was oxycodone 5 mg immediate release tablet (42.2%) and most common surgery type among the population was cesarean section (26.5%). Of the 332 patients, 4 (1.2%) filled more than 10 opioid prescriptions within 1 year after discharge, and 4 (1.2%) had more than 90 days of continuous use of opioids within 1 year after discharge. Of the patients who filled more than 10 opioid prescriptions and had more than 90 days of continuous use of opioids, all 4 of the patients were from the comparator group that had been discharged with 3 days or less supply of opioid upon discharge (P=1.000) . None of the patients in the study group filled more than 10 opioid prescriptions or had more than 90 days of continuous opioid use after discharge. The average number of fills at 3 months after discharge was 1.09, at 6 months was 1.18, and after 1 year was 1.36.
Conclusion: Patients who were prescribed ≥ 3 days of opioids post-operatively at discharge did not have an increase in long term usage of opioids after 1 year.
