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

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Abstract
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. 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. 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. 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.

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