Trends in Use of Medications for Opioid Use Disorder among Commercially Insured U.S. Surgical Patients, 2016 to 2022

The optimal management of perioperative pain in patients using medications for opioid use disorder (MOUD) is unclear. To motivate and inform efforts to develop evidence-based guidelines for perioperative pain management in these patients, it is important to evaluate whether the prevalence of MOUD use in surgical patients is increasing and to identify which procedures have the highest rate of MOUD use.

This cohort study analyzed adults 18 to 64 yr undergoing 1 of 1,083 major surgical procedures from 2016 to 2022 from the Merative MarketScan Commercial Database, which includes commercial claims from 22 to 28 million privately insured patients annually. Annual changes in MOUD use from 1 to 180 days before surgery were evaluated using logistic regression models adjusting for patient demographics and comorbidities. For each procedure category, the prevalence of MOUD use among all instances of the procedure during 2016 to 2022 was calculated.

Analyses included 8,137,973 surgical admissions for 5,013,213 adults (59.9% female). The adjusted prevalence of MOUD use increased from 55.2 per 100,000 in 2016 to 99.8 per 100,000 in 2022 (adjusted annual change, 16.9 per 100,000 procedures; 95% CI, 14.0 to 19.8). Among 15,701 surgical admissions for patients using MOUD during 2016 to 2022, the most common type of MOUD was buprenorphine (13,193; 84.0%). Procedures with the highest rate of MOUD use were debridement (719.0 per 100,000 procedures), shoulder arthroplasty (579.4 per 100,000 procedures), lower extremity amputation (529.6 per 100,000 procedures), and hip or pelvis open fracture repair (497.6 per 100,000 procedures).

In this cohort study of surgical procedures among privately insured U.S. adults, the prevalence of MOUD use increased between 2016 and 2022, highlighting the importance of developing evidence-based guidelines for perioperative management of these patients. The high rates of MOUD use in common orthopedic procedures suggest that these guidelines may be particularly relevant to the practice of orthopedic surgeons.