SynthesisPain medicine (Malden, Mass.)2026
Patient-related risk factors for new persistent opioid use after surgery among opioid-naïve individuals in the United States: a systematic review and meta-analysis.
Synthesis in Pain medicine (Malden, Mass.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveOne in nine Americans will undergo a surgical procedure during their lifetime and, for some, the treatment of postoperative pain represents their first prolonged exposure to an opioid. New persistent opioid use (NPOU) refers to continued opioid use beyond the typical surgical recovery period (3 months) in opioid-naïve patients and has been linked to increased morbidity, mortality, and opioid-related complications. This systematic review with meta-analysis synthesized the recent evidence on patient-related risk factors for NPOU among opioid-naïve postsurgical adults in the United States to derive a pooled effect size for evaluable factors using a random-effects model (PROSPERO: CRD420250651059).
methodsWe followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement and checklist. The level of evidence and methodological quality were assessed using the Joanna Briggs Institute checklist. Estimates of associations and CIs were extracted. Risk factors were categorized as either sociodemographic, clinical, or opioid exposure factors using a narrative synthesis. A random effects meta-analysis of estimates of association was performed.
resultsA comprehensive literature search resulted in 27 articles; all were retrospective cohort studies and 89% were deemed of good quality. Among the various risk factors identified through narrative synthesis, mood disorders, anxiety, Medicaid enrollment, and preoperative benzodiazepine use were the most predictive of NPOU. The pooled odds ratios for these risk factors from meta-analysis were 1.24 (95% CI, 1.17-1.32), 1.17 (1.11-1.23), 1.77 (1.46-2.15), and 1.77 (1.53-2.05), respectively.
conclusionOpioid-naïve persons insured by Medicaid or with preoperative anxiety, depression, or benzodiazepine use, are associated with a higher risk for NPOU.
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