Factors Associated with Opioid Refills at 31-60 and 61-90 Days After Discharge from Spine Surgery: Potential Screening Marker for Transitional Pain Service

Background: Although 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 2-3 months following 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-naive status, who underwent spine surgery at an academic medical center and were discharged between January 2017 and December 2023. Data were analyzed using multiple logistic and linear regressions and Fisher exact test. Results: Of the patients, 25.4% and 14.8% received opioid refills at 31-60 and 61-90 days post-discharge, respectively. Among the independent risk factors, a refill at 31-60 days was the strongest predictor of a refill at 61-90 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 31-60 and 61-90 days were linearly correlated (p<0.0001, slope=0.73). A refill at 31-60 days predicted a refill at 61-90 days with a negative predictive value (NPV) of 94.3% and a positive predictive value of 41.5%, with consistently high NPVs across subgroups defined by preoperative opioid use, surgical procedure, or surgeon. A refill at 1-30 days; preoperative use of opioids, marijuana, and benzodiazepine; the first postoperative pain score recorded on hospital floor; and depression were all associated with increased odds of refills at both 31-60 and 61-90 days. In contrast, the total dose of discharge opioid prescriptions had minimal impact on refills. Conclusion: A refill at 31-60 days after discharge may serve as a screening marker for identifying 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.