Authors: Ye F et al.
Anesthesia & Analgesia, February 25, 2026.
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.
This retrospective cohort study examined predictors of opioid prescription refills during the critical transition period between acute postoperative pain management and potential persistent opioid use after spine surgery. Although transitional pain services (TPS) have been proposed to help manage patients at risk for long-term opioid use, clear criteria for identifying high-risk patients remain limited.
The investigators analyzed electronic medical records of 11,087 adult patients who underwent inpatient spine surgery at a large academic medical center between 2017 and 2023. Patients were included regardless of whether they were opioid-naïve before surgery. The primary goal was to identify factors associated with opioid refills during two important postoperative intervals:
• 31 to 60 days after discharge
• 61 to 90 days after discharge
These periods represent a critical window when short-term postoperative opioid use may transition into persistent or chronic use.
The results demonstrated that opioid refills during this period were common. Overall, 25.4% of patients received an opioid refill between 31 and 60 days after discharge, and 14.8% received a refill between 61 and 90 days.
The strongest predictor of later opioid refills was whether a patient had already received a refill during the 31 to 60 day interval. Patients with a refill during this time were more than six times more likely to receive another refill between 61 and 90 days (adjusted odds ratio 6.71).
Refill patterns showed a strong linear relationship between the two time periods. Importantly, the absence of a refill at 31 to 60 days was highly predictive of not requiring a refill later. The negative predictive value was 94.3%, meaning patients who did not require a refill during the 31 to 60 day period were very unlikely to need opioids during the 61 to 90 day period.
Several additional factors were independently associated with increased odds of opioid refills in both time windows. These included:
• Opioid refill during the first 30 days after discharge
• Preoperative opioid use
• Preoperative marijuana use
• Preoperative benzodiazepine use
• Higher first postoperative pain score recorded on the hospital ward
• History of depression
Interestingly, the total opioid dose prescribed at discharge had minimal impact on refill rates. This finding suggests that patient-specific factors and early refill patterns are more important determinants of prolonged opioid use than the initial prescription amount.
The authors propose that the presence of a refill during the 31 to 60 day period may serve as a practical clinical marker identifying patients at risk for persistent opioid use. Such patients may benefit from targeted interventions such as transitional pain service management, closer follow-up, or alternative pain management strategies.
The study highlights the importance of careful monitoring of opioid prescriptions after spine surgery and suggests that each refill decision should be considered an opportunity to intervene before long-term opioid use develops.
Key Points
• Persistent opioid use after surgery often develops during the 2–3 month postoperative period.
• In this cohort of more than 11,000 spine surgery patients, 25.4% received opioid refills at 31–60 days and 14.8% at 61–90 days.
• A refill at 31–60 days was the strongest predictor of a refill at 61–90 days (adjusted odds ratio 6.71).
• Absence of a refill at 31–60 days strongly predicted no later refill (negative predictive value 94.3%).
• Risk factors included early refills, preoperative opioid use, marijuana use, benzodiazepine use, depression, and higher postoperative pain scores.
• The dose of opioids prescribed at discharge had minimal influence on later refills.
• Monitoring refill patterns may help identify patients who would benefit from transitional pain service interventions.
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