Pre- and Postoperative Prescription of Opioids and Benzodiazepines in the US

Postoperative opioid and benzodiazepine use often extends beyond recovery, yet research on surgical prescribing tends to focus on opioid-naive patients. Less is known about those already using these medications preoperatively, who face different risks and care needs.

Using a national US claims database (PearlDiver, 2010 to 2022), we identified insured adults receiving 1 of 18 common surgeries. We examined patterns of filled prescriptions for opioids and benzodiazepines before and after surgery, including (1) opioids without benzodiazepines (opioid monotherapy), (2) benzodiazepines without opioids (benzodiazepine monotherapy), (3) exposure to both, and (4) exposure to neither. Preoperative prescriptions were assessed between 6 months and 1 week before surgery. Postoperative prescriptions between 1 and 3 months after surgery were assessed. Using multivariable logistic regression, we analyzed relationships between preoperative and postoperative opioid and benzodiazepine medication fills.

Among 14.9 million adults, 62% and 80% were opioid- and benzodiazepine-naive preoperatively. Among opioid and benzodiazepine-naive patients, 21.4% initiated these medications postoperatively. In contrast, 51% of preoperative opioid and benzodiazepine users filled prescriptions after surgery. Although >80% of patients on preoperative benzodiazepine monotherapy no longer received benzodiazepines postoperatively, benzodiazepine monotherapy strongly predicted exposure to benzodiazepine monotherapy (adjusted odds ratio 24.10 [23.88 to 24.32]) and both opioid and BZDs (adjusted odds ratio 15.59 [15.51 to 15.88]).

Postoperative prescribing may reflect patients' preexisting opioid and benzodiazepine use more than new surgical indications. Understanding these trajectories is key for developing surgery-specific interventions, especially for patients with preoperative opioid and benzodiazepine exposure.