[Persistent Postoperative Opioid Use]

Persistent postoperative opioid use (PPOU) has become an important quality indicator in perioperative medicine. While the North American opioid crisis has raised global awareness, data from Germany and other European countries have been limited. Recent population-based and clinical studies now provide robust evidence that PPOU is overall uncommon in Germany, with an incidence of approximately 1-1.4% among previously opioid-naïve patients. However, substantial variation exists between surgical procedures. Major amputations, spine surgery and revision arthroplasty show markedly elevated risks, indicating that the type of surgery is the strongest predictor of PPOU, exceeding the influence of patient-related factors. Psychiatric comorbidities, chronic pain, and especially preoperative opioid therapy significantly increase vulnerability. Perioperative processes also modulate risk: opioid administration on first postoperative day in patients with low pain intensity is associated with a higher likelihood of PPOU, whereas adequate opioid use in patients with severe pain does not increase this risk. High-quality multimodal analgesia, early integration of regional anesthesia, structured acute pain services and clear discharge recommendations are essential to prevent unnecessary long-term opioid use. These findings highlight the multifactorial nature of PPOU and underscore the importance of individualized, guideline-conform perioperative pain management. Targeted risk assessment, optimized perioperative pathways and coordinated follow-up care are key strategies to minimize persistent opioid use and improve postoperative outcomes.