Use and Outcomes of Medication for Opioid Use Disorder Among Patients With Opioid Use Disorder Undergoing Surgery

We examined patterns of use of perioperative medication for opioid use disorder (MOUD) in patients undergoing surgical procedures and assessed the association between MOUD use and perioperative opioid use and postsurgical adverse events.

Optimal management of patients with opioid use disorder (OUD) undergoing surgery is unknown.

We identified patients who underwent major and minor surgery from 2016 to 2021 in the MarketScan Database. Patients were classified into OUD and non-OUD groups (opioid-naïve, intermittent use, and chronic use). Among patients with OUD, preoperative MOUD (buprenorphine, methadone) use was noted. Outcomes were compared between patients with and without OUD and among OUD patients who used or did not use MOUD.

Of 917,754 surgical patients, 1.6% had OUD, 63.7% were opioid-naïve, 27.8% were intermittent opioid users, and 6.8% were chronic opioid users. Among OUD patients, 27.6% were current MOUD users before surgery. Compared to opioid-naïve patients, patients with OUD had higher rates of persistent perioperative opioid use (42.2% vs. 8.2%), higher rates of emergency department (ED) visits (21.7% vs. 6.9%), and higher rates of readmissions (6.6% vs. 2.2%) within 30 days following surgery (all P < 0.05). Among patients with OUD, current MOUD use was associated with lower perioperative opioid use compared with no MOUD (53.7% vs. 82.9%), lower persistent postoperative opioid use (13.8% vs. 56.7%), lower rates of ED visits (18.3% vs. 22.3%), and lower readmission rates (4.8% vs. 7.2%) (all P < 0.05), compared to untreated OUD patients.

Among patients with OUD undergoing surgery, preoperative current MOUD is associated with reduced postoperative opioid use, and fewer ED visits and readmissions compared to patients who had a diagnosis of OUD but were untreated.