Concurrent Perioperative Benzodiazepine and Opioid Utilization in Opioid-Naive Patients Undergoing Soft Tissue Hand...

Area of Science:

• Orthopedic Surgery
• Pain Management
• Pharmacology

Background:

• Concomitant opioid and benzodiazepine use increases sedation and overdose risks.
• Perioperative opioid prescribing patterns in hand surgery patients using benzodiazepines are not well-understood.

Purpose of the Study:

• To investigate perioperative opioid utilization in opioid-naive hand surgery patients concurrently using benzodiazepines.
• To assess the association between preoperative benzodiazepine use and opioid prescription, new persistent opioid use, and postoperative outcomes.

Main Methods:

• Analysis of an administrative claims database (2011-2021) for adult hand surgery patients.
• Identification of opioid-naive patients with benzodiazepine prescriptions within 90 days pre-surgery.
• Multivariable regression models adjusted for demographic and clinical factors to evaluate outcomes including opioid prescriptions, new persistent opioid use, ED visits, and hand therapy.

Main Results:

• Patients using benzodiazepines had significantly higher adjusted odds of receiving perioperative opioid prescriptions and higher amounts of opioids filled.
• Benzodiazepine users showed a 1.48-fold increased odds of developing new, persistent opioid use compared to non-users.
• Preoperative benzodiazepine use was associated with increased postoperative emergency department visits and hand therapy utilization.

Conclusions:

• Opioid-naive hand surgery patients using benzodiazepines are prescribed opioids more frequently and in higher amounts.
• These patients face an increased likelihood of developing new, persistent opioid use.
• Surgeons should consider reducing opioid prescriptions for patients on benzodiazepines, favoring non-opioid pain management strategies.