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

Bicket MC, McGee MF, Gunaseelan V, Englesbe MJ, Lagisetty P, Brummett CM, Bohnert A, Li Y, Waljee JF. Opioid Consumption and Fills after Surgery in Adults on High-Dose Prescription Opioids. Journal of the American College of Surgeons. 2026 Mar 13 DOI: 10.1097/XCS.0000000000001919.

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Abstract:

BACKGROUND: Preoperative high-dose opioid use complicates perioperative pain management, yet postoperative consumption and refill patterns relative to opioid-naïve patients remain poorly defined. We compared 30-day opioid consumption and 90-day prescription fills after common surgical procedures by preoperative opioid exposure. STUDY DESIGN: We conducted a retrospective cohort study of adults undergoing surgery (January 1, 2019-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 with ≥30 mg oxycodone equivalents or any extended-release opioid), low-dose, or opioid-naïve. 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 standard errors were used. RESULTS: Among 72,616 patients (5,346 high-dose; 14,180 low-dose; 53,090 opioid-naïve), adjusted mean 30-day consumption was 4.6 pills (95% CI 4.3-4.9) for high-dose patients, 3.9 (3.8-4.1) for low-dose, and 3.2 (3.1-3.3) for opioid-naïve 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 (27.1%) and opioid-naïve patients (8.2%). At the 75th percentile, total 90-day fill size was 360 pills for high-dose patients versus 92 and 24 pills, respectively. Among high-dose patients, mean daily postoperative opioid use was similar to or lower than preoperative levels. CONCLUSIONS: Patients with high-dose preoperative opioid exposure report clinically similar 30-day postoperative consumption as opioid-naïve 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.