Independent Factors Associated With Opioid Refills at 31 to 60 and 61 to 90 Days After Discharge From Spine Surgery: A Novel Predictor of High-Risk Patients

BACKGROUND: Although the transitional pain service (TPS) has been proposed to manage patients at risk for persistent postsurgical opioid use, no standard criteria exist to identify high-risk patients for TPS management. Specifically, the 2 to 3 months after surgery are critical for the transition from short-term to persistent opioid use, yet little is known about opioid refills during this period. METHODS: This retrospective cohort study included 11,087 adult patients, regardless of opioid-naïve status, who underwent inpatient spine surgery at an academic medical center and were discharged between January 2017 and December 2023. The cohort was identified, and data were obtained from electronic medical records. Data were analyzed using multiple logistic and linear regression and Fisher’s exact test. RESULTS: Of the patients, 25.4% and 14.8% received opioid refills at 31 to 60 and 61 to 90 days postdischarge, respectively. Among the indepen dent risk factors, a refill at 31 to 60 days was the strongest predictor of a refill at 61 to 90 days (aOR 6.71, 95% CI, 5.90–7.65), regardless of preoperative opioid use, cervical or lumbar procedures, or surgical service. Refill rates at 31 to 60 and 61 to 90 days were linearly correlated ( P < .0001, slope = 0.73). A refill at 31 to 60 days predicted a refill at 61 to 90 days with a negative predictive value (NPV) of 94.3% and a positive predictive value (PPV) of 41.5%, with consistently high NPVs across subgroups defined by preoperative opioid use, surgical procedure, or surgeon. A refill at 1 to 30 days; preoperative use of opioids, marijuana, and benzodiazepine; the first postoperative pain score recorded on the hospital floor; and depression were all associated with increased odds of refills at both 31 to 60 and 61 to 90 days. In contrast, the total dose of discharge opioid prescriptions had minimal impact on refills. CONCLUSIONS: A refill at 31 to 60 days after discharge may serve as a predictor of high-risk patients who could benefit from TPS management to mitigate further opioid use. Moreover, each refill prescription should be carefully managed to prevent subsequent refills.