Medication for Opioid Use Disorder and Perioperative Outcomes for Benign Hysterectomy

To evaluate the association between medication for opioid use disorder (MOUD) and surgical complications and health care utilization among patients with opioid use disorder (OUD) undergoing hysterectomy.

Using MarketScan Research Databases (2016-2021), we identified patients with OUD who underwent hysterectomy for benign indications. Use of MOUD (methadone or buprenorphine) was assessed within 1 year preoperatively, distinguishing among prior MOUD use (365 to 31 days preoperatively), current MOUD use (30 to 1 days preoperatively), and nonuse of MOUD. The primary outcomes included perioperative surgical complications. The secondary outcome included perioperative and postoperative opioid prescription, 30-day readmissions, and emergency department (ED) visits within 30 and 90 days. Propensity scores inverse probability of treatment weighting was used to evaluate the association between current MOUD and outcomes.

Of 1,715 patients with preoperative OUD who underwent hysterectomy, 491 (28.6%, 95% CI, 26.5-30.8%) reported current MOUD use. Current MOUD use was associated with fewer perioperative complications than nonuse of MOUD (27.7% vs 33.9%, adjusted risk ratio 0.86, 95% CI, 0.76-0.97), including surgical site (12.8% vs 16.9%) and medical (17.5% vs 22.8%) complications. Current MOUD use was also associated with fewer ED visits within 30 days (19.1% vs 27.7%) and 90 days (32.6% vs 42.8%). Buprenorphine and methadone had similar outcomes. Patients on MOUD for more than 90 days had lower risks of complications and health care utilization than those on MOUD for 90 days or less.

Among patients with OUD undergoing hysterectomy, MOUD use was associated with reduced perioperative complications and health care utilization. Findings support methadone and buprenorphine use to improve hysterectomy surgical outcomes, particularly with more than 90 days of MOUD.