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for intervention success. Future research on the impact of specific modifications will help determine which are detrimental or beneficial to patient outcomes and sustainability of services. Modifications made during intervention implementation were classified using Stirman and colleagues' framework. Despite the modifications, adherence rates improved and were consistent with expectations based on prior studies of similar interventions. These findings support previous implementation research on adaptability and suggest that the ability

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3% (95% CI 66.1-70.4) and 76.3% (95% CI 74.0-78.5) respectively. Risk factors associated with new chronic post-operative opioid use included female gender, underweight and obesity, pre-operative comorbidities, acute surgery, ICU-time1day, and post-operative complications. Strongest predictor of chronic post-operative opioid use was post-discharge use of opioid within one month after surgery (odds ratio 3.3, 95% CI 2.8-4.. New chronic post-operative opioid use after open cardiac surgery is common. Focus on post-discharge opioid use