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 significant number of opioid-naïve patients transition to 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 has been published in Pain Medicinehas identified the patient-specific risk factors that most accurately predict which individuals are at highest risk for this dangerous transition. The study, which synthesized data from 27 high-quality studies, found that four main factors significantly increase the odds that a patient will become a long-term opioid user after surgery: Medicaid enrollment, preoperative benzodiazepine use, mood disorders, and anxiety.
Identifying who is at risk before the first cut is made is a critical step in combating 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 PhD student
The risk factor distribution
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 a 77% higher chance of 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.
- Worry: Patients with pre-existing anxiety disorders were 17% more likely to use persistently.
A call for a holistic preoperative checkup
NPOU is defined as the continued use of opioids beyond three months after surgery and has been associated with increased morbidity, higher mortality rates, and long-term complications.
The study’s findings underscore that “opioid-decision” status, meaning the patient has not used opioids recently, is not a stand-alone guarantee of safety. Emphasizing that social determinants (such as insurance type) and psychological factors (such as stress) are as influential as the surgery itself, the researchers advocate a more comprehensive approach to preoperative screening. Incorporating these evidence-based insights into clinical practice may help prevent adverse outcomes of surgical pain management and improve long-term patient outcomes nationwide. Authors of this study include Rosemary C. Polomano. Heath D. Schmidt, PhD; Jungwon Min, PhD; and Peggy A. Compton, PhD; all of Penn Nursing.
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