Prevalence, Trajectories, and Predictors of Persistent Postoperative Opioid Use in a Swiss University Hospital: A Prospective Observational Study

Background: Persistent postoperative opioid use (PPOU) is a growing concern, yet European data remain scarce. Switzerland has experienced a rise in opioid prescriptions, yet long-term opioid use after surgery is poorly characterized. Methods: This single-center prospective observational cohort included adults undergoing elective surgeries at risk for chronic postsurgical pain at the University Hospitals of Geneva. Opioid consumption (morphine milligram equivalents) was assessed preoperatively, 24 h before discharge, and at 6 months. The primary objective was to quantify PPOU prevalence and trajectories at 6 months; secondary objectives were to identify clinical and psychological predictors of PPOU. Results: Among 338 patients, 19% were preoperative opioid users; 32% of them continued opioids at 6 months. Overall, 8.6% of all patients had persistent opioid consumption, including 3% who were opioid-naïve before surgery. PPOU was most frequent after spine and orthopedic surgery. Conclusion: Preoperative opioid use and type of surgery are key predictors of PPOU, highlighting spine and orthopedic procedures, and patients with preexisting pain, as priority targets for opioid-sparing and multimodal strategies.