New persistent opioid use among patients with behavioral health disorders following major surgery

Patients with substance use or mental health disorders may have differential responses to pain after surgery, which may result in higher opioid use. We sought to characterize the association of behavioral health disorders with new persistent opioid use after a major surgical procedure.

Patients who underwent a major surgical procedure between 2013 and 2020 were identified using the IBM-MarketScan database. Behavioral health disorders included medicinal use disorders, eating/sleeping disorders, or mental health disorders. New persistent opioid use was defined as 2 subsequent opioid refills within 3 and 6 months after surgery among opioid-naïve patients. Multivariable regression was applied to study the association between behavioral health disorders and risk of new persistent opioid use.

Among 62,585 patients (coronary artery bypass graft: n = 20,338, 32.5%; pneumonectomy: n = 6,986, 11.2%; abdominal aortic aneurysm repair: n = 1,783, 2.9%; pancreatectomy: n = 1,768, 2.8%; and colectomy: n = 31,710, 50.7%), most were male (n = 37,868, 60.5%) with a median age of 56 (interquartile range: 50-60) years; 23.9% (n = 14,986) had diagnosis of behavioral health disorders before surgery. A total of 27.7% (n = 17,315) of patients had postoperative opioid use, among whom 17.5% (n = 3,034) developed new persistent opioid use with a median dose of 438 (interquartile range: 234-870) morphine milligram equivalents. Patients with behavioral health disorders had a higher incidence of new persistent opioid use (behavioral health disorder: 20.3% vs no behavioral health disorder: 16.6%) with a higher median morphine milligram equivalent dose (behavioral health disorder: 450, interquartile range: 230-960 vs no behavioral health disorder: 435, interquartile range: 234-845) (both P < .05). On multivariable analysis, behavioral health disorders were associated with 32% higher odds of new persistent opioid use (odds ratio: 1.32, 95% confidence interval: 1.21-1.44) compared with no behavioral health disorders.

Roughly 1 in 5 patients with behavioral health disorders who underwent major surgery developed new persistent opioid use. Patients undergoing surgery often have a high prevalence of behavioral health disorders, which can increase the risk of higher opioid use.