Opioid Risk Tool Scores are Not Associated With Opioid Misuse After Elective General Surgery: A Prospective Study

Assessment for opioid misuse is not widely utilized preoperatively. Yet, it can offer valuable clinical insight for patient counseling. The opioid risk tool (ORT) and its opioid use disorder-specific variant (ORT-OUD) predict opioid misuse in chronic pain patients. Although recommended for surgical patients, neither has been validated. Herein, we sought to validate the ORT and ORT-OUD in patients undergoing elective general surgery procedures.

This was a prospective observational study. Consented patients filled out the ORT. Demographics, prescribed opioids, and adjuncts were collected. Pain control ratings after surgery and whether patients were still using opioids were collected at 30 days post surgery. Patients were grouped as low, medium, and high-risk for opioid misuse based on ORT or ORT-OUD scores and compared. P < 0.05 was considered significant.

We included 178 patients; 139, 28, and 11 scored low, medium, and high-risk on the ORT, respectively. Compared to low-risk, medium-risk and high-risk patients were more likely to call for pain (8% versus 32.1% versus 36.4%; P < 0.001) and rate their pain control as poor or fair (8.5% versus 25% versus 18.2%; P = 0.047). Only three opioid-naïve patients were still using opioids 30 days post surgery; they all scored low-risk on ORT. Similar results were obtained with the ORT-OUD.

Although higher ORT scores are associated with worse pain satisfaction and an increased likelihood of a phone call for pain, the ORT and ORT-OUD were not validated as predictive tools for prolonged opioid use or opioid misuse following elective general surgery.