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OBJECTIVE We examined long-term health outcomes associated with new persistent opioid use after surgery and hypothesized that patients with new persistent opioid use would have poorer overall health outcomes compared to those who did not develop new persistent opioid use after surgery. SUMMARY BACKGROUND DATA New persistent opioid use is a common surgical complication. Long-term opioid use increases risk of mortality, fractures, and falls; however, less is known about healthcare utilization among older adults with new persistent opioid use following surgical care. METHODS We analyzed claims from a 20% national sample of Medicare beneficiaries ≥65 years undergoing surgery between 1/1/09-6/30/19. We estimated associations between new persistent use and subsequent health events between 6-12 months after surgery, including mortality, serious fall/fall-related injury and respiratory or opioid/pain-related readmission/emergency department (ED) visits using a Cox proportional hazards model to estimate mortality and multivariable logistic regression for the remaining outcomes, adjusting for demographic/clinical characteristics. Our primary outcome was mortality within 6-12 months after surgery. Secondary outcomes included falls and readmissions or ED visits (respiratory, pain/opioid-related) within 6-12 months after surgery. RESULTS Of 229,898 patients, 6,874 (3.0%) developed new persistent opioid use. Compared to patients who did not develop new persistent opioid use, patients with new persistent opioid use had a higher risk of mortality (HR 3.44, CI 2.99-3.96), falls (aOR 1.21, 95% CI 1.05-1.39) and respiratory-related (aOR 1.67, 95% CI 1.49-1.86) or pain/ opioid-related (aOR 1.68, 95% CI 1.55-1.82) readmissions/ED visits. CONCLUSIONS New persistent opioid use after surgery is associated with increased mortality and poorer health outcomes after surgery. Although the mechanisms that underlie this risk are not clear, persistent opioid use may also be a marker for greater morbidity requiring more greater care in the late postoperative period. Increased awareness of individuals at risk for new persistent use after surgery and close follow-up in the late postoperative period is critical to mitigate the harms associated with new persistent use.