Key Points Question Can a risk score for sustained prescription opioid use after surgery be developed for a working-age population using readily available clinical information? Findings In this case-control study of 86 356 patients undergoing 1 of 10 common surgical procedures, prior opioid exposure was the factor most strongly associated with sustained opioid use. The group with the lowest Stopping Opioids After Surgery scores (<31) had a mean 4.1% risk of sustained opioid use; the group with intermediate scores (31-50) had a mean risk of 14.9%; and the group with the highest scores (>50) had a mean risk of 35.8%. Meaning The scoring system developed in this study may inform the risk of sustained prescription opioid use after surgery and be scalable to clinical practice.

Background: Prior opioid use has been shown to be associated with adverse outcomes in surgical and trauma patients. We sought to evaluate the influence of prior opioid use on prescription opioid requirements after orthopedic trauma. Materials and methods: This was a retrospective review of TRICARE claims (2006-2014). We evaluated the records of 11,752 patients treated for orthopedic injuries. Surveillance for prior opioid exposure extended to 6 mo before the traumatic event, with similar postinjury surveillance. Preinjury opioid use was categorized as unexposed, exposed without sustained use (nonsustained users), and sustained use (6 mo or longer of continuous opioid prescriptions without interruption). Multivariable Cox proportional hazard models were used to adjust for confounding and determine factors independently associated with the discontinuation of prescription opioid use after traumatic injury. Results: Prior opioid exposure among nonsustained users (hazard ratio 0.78; 95% CI 0.74, 0.83) and sustained use at the time of injury (hazard ratio 0.40; 95% CI: 0.35, 0.47) were associated with lower likelihoods of opioid discontinuation. Additional factors associated with lower likelihoods of opioid discontinuation included our proxy for lower socioeconomic status, history of depression or anxiety, injury severity, and intensive care unit admission. Conclusions: Prior opioid use is one of the strongest predictors of continued use following treatment, along with socioeconomic status, behavioral health disorders, and severity of injury. Appropriate discharge planning and early engagement of ancillary services in

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