New persistent opioid use following surgery among opioid-naïve patients in the USA: a systematic review and meta-analysis of observational studies

BACKGROUND: New persistent opioid use (NPOU) after surgery is a serious surgical complication associated with increased risk of opioid abuse, mortality, morbidity, and greater healthcare resource utilization. OBJECTIVE: This meta-analysis aimed to estimate the pooled incidence of NPOU following surgery in the USA and examine its association with selected risk factors, patient characteristics, and study characteristics. EVIDENCE REVIEW: PubMed and Embase were searched on March 1, 2024, to identify observational studies published between January 1, 2013, and March 1, 2024, that reported the incidence of NPOU among adult patients newly prescribed opioids for postsurgical pain. Study quality was assessed using the Newcastle-Ottawa Scale for cohort studies. Pooled incidence estimates of NPOU were generated using random-effects models overall and within subgroups stratified by surgery type, payer coverage, exclusion of subsequent analgesia/surgery, and NPOU definitions. Meta-regression analyses were conducted to explore associations between NPOU and select patient attributes. The protocol was registered in PROSPERO (CRD42023446403). FINDINGS: =100%) and a 95% prediction interval of 1.34% to 17.02%. Metaregression analyses indicated that the pooled estimate was not significantly associated with study sample size, racial distribution, proportion of male patients, or mean age. Estimates of NPOU did not differ significantly by surgery type (p=0.4912), payer coverage (p=0.0697), or subsequent analgesia/surgery (p=0.6335). However, incidence estimates were significantly higher in the 35 studies defining NPOU as opioid use within 90-180 days after surgery (8.29%, p