579: Prevalence and risk factors for persistent post-operative opioid use after major surgery in England

Topic: Education, Societal Impact, and Others
Subtopic: Epidemiology

Background and Aims: Persistent post-operative opioid use (PPOU) is increasingly recognised as an important adverse outcome following major surgery, contributing to long-term opioid dependence, reduced quality of life and increased healthcare utilisation (1,2). While evidence from North America suggests that 5–10% of opioid-naïve surgical patients develop persistent opioid use, UK-specific data remain limited and differences in prescribing systems and perioperative care pathways limit generalisability (3-7). Understanding the epidemiology of PPOU within the UK context is essential to inform prevention strategies and opioid stewardship initiatives. This study aimed to estimate the prevalence of PPOU following major surgery in England and identify associated risk factors.

Methods: Population-based cohort study using primary care data from the Clinical Practice Research Datalink (CPRD) GOLD, linked to Hospital Episode Statistics (HES) covering the period 1st January 2000–31st December 2020. We followed adults (≥18 years) after major surgery who received an opioid prescription within 30 days of hospital discharge. PPOU was defined as an opioid prescription issued in primary care within 30 days of discharge, followed by at least one additional prescription between 91 and 180 days post-discharge. Multivariable logistic regression was used to identify risk factors, with analyses stratified by pre operative opioid exposure.

Results: Among 91,528 patients prescribed opioids within 30 days of discharge (24.4% of all major surgical patients), 45,872 met the PPOU definition (50.1%). This corresponds to 12.2% of all major surgical patients in the eligible cohort (45,872/375,514). PPOU occurred in 24.9% of opioid naïve patients (10,791/43,407) and 72.9% of opioid tolerant patients (35,081/48,121). The strongest predictor of PPOU was pre operative opioid exposure. Other significant risk factors included long acting opioid formulations and higher post discharge doses.

Conclusions: Pre-operative opioid use was the strongest predictor of persistent post-operative opioid use (PPOU), with opioid-naive patients significantly less likely to develop PPOU than prevalent users. Additional risk factors included exposure to long-acting opioid formulations and higher post-discharge opioid doses, highlighting the importance of perioperative prescribing decisions in shaping longer-term outcomes. These findings underscore the need for targeted risk stratification, careful opioid stewardship before surgery, and structured post-discharge review to minimise unnecessary continuation. Interventions focusing on pre-operative optimisation, dose limitation, and early tapering support may reduce the incidence of PPOU and mitigate downstream harms within surgical pathways in the UK setting.

References: 1. Levy N, Quinlan J, El-Boghdadly K, Fawcett WJ, Agarwal V, Bastable RB, et al. An international multidisciplinary consensus statement on the prevention of opioid-related harm in adult surgical patients. Anaesthesia. 2021;76(4):520-36.
2. Hah JM, Bateman BT, Ratliff J, Curtin C, Sun E. Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic. Anesth Analg. 2017;125(5):1733-40.
3. Kim SC, Choudhry N, Franklin JM, Bykov K, Eikermann M, Lii J, et al. Patterns and predictors of persistent opioid use following hip or knee arthroplasty. Osteoarthritis and Cartilage. 2017;25(9):1399-406.
4. Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, et al. New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. JAMA Surg. 2017;152(6):e170504.
5. Finstad J, Røise O, Rosseland LA, Clausen T, Havnes IA. Discharge from the trauma centre: exposure to opioids, unmet information needs and lack of follow up—a qualitative study among physical trauma survivors. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2021;29(1):121.
6. Hill MV, McMahon ML, Stucke RS, Barth RJ, Jr. Wide Variation and Excessive Dosage of Opioid Prescriptions for Common General Surgical Procedures. Ann Surg. 2017;265(4):709-14.
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Presenting Author: Neetu Bansal
Submitting Author: Neetu Bansal

Senior Author: Li-Chia Chen

IASP 2026 Global Year theme of Neuropathic Pain: No

• Darren Ashcroft - University of Manchester
• Alison K Wright - University of Manchester
• Sujesh Bansal - Manchester University Hospitals NHS Trust
• Roger Knaggs - University of Nottingham
• Christopher Armitage - University of Manchester
• Li-Chia Chen - University of Manchester