Community-Level Health Indices and New Persistent Opioid Use: An Analysis of Surgical Patients in an Appalachian Population

Background Persistent post-operative opioid use (PPOU) contributes to the North American opioid crisis, with 7–10% of patients continuing to refill opioid prescriptions 90 days or longer after surgery. This study investigates the relationship between community-level indices (including zip code and census tract) standard determinants of health, and their ability to correlate with the risk for individual surgical patients having PPOU. Methods We conducted a retrospective observational study of 913 opioid-naïve patients who underwent colectomy, mastectomy, or nephrectomy at The University of Tennessee Medical Center between 2018 and 2022. Four validated public health tools were utilized to determine if they were associated with patients at risk: the CDC’s Social Vulnerability Index (SVI), the Vizient Vulnerability Index (VVI), the Distressed Community Index (DCI), and the Community Needs Index (CNI). Census tract and zip codes were used to obtain the corresponding scores. The primary outcome was PPOU, defined as opioid prescription at discharge plus ≥ 1 additional opioid prescription between 60–90 days. Univariate and multivariable logistic regression models assessed associations with PPOU, adjusting for demographic, psychosocial, and surgical factors. Results PPOU occurred in 8.6% (73/913) of patients. Patients with PPOU had longer hospital stays (median 2.7 vs 2.1 days, p = 0.040) and were more likely to undergo total/radical resection versus partial (57.5% vs 33.6%, p < 0.001), corresponding to 2.7-fold increased odds of PPOU (OR 2.68, 95% CI 1.65–4.36). No significant differences were observed in demographics, psychiatric history, BMI, recreational drug use, or perioperative nerve block use. None of the community-level indices were associated with PPOU in univariate or multivariate analysis (all p > 0.15). Ninety-day readmission was strongly associated with PPOU (adjusted OR ≈ 7.0, p < 0.001). Conclusion This Appalachian cohort’s community-level indices were not associated with individual PPOU, suggesting that ecological metrics may have limited utility for patient-level opioid risk stratification. Postoperative clinical course and surgical magnitude were strongly associated with PPOU, highlighting actionable perioperative intervention targets such as optimizing recovery pathways and monitoring patients with readmission or extensive procedures. Future research should evaluate individualized predictive models integrating clinical, behavioral, and biologic determinants rather than relying on aggregated community measures.