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

Authors

• Amy Y. Zhao, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Philip M. Parel, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Donovan T. Maust, Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Ann Arbor, MI, USA.
• Monica Sala-Rabanal, Center for Health and Science Communication, Bernard Becker Medical Library, Washington University School of Medicine, Saint Louis, MO, USA.
• Richard A. Grucza, Departments of Family and Community Medicine and Health and Clinical Outcomes Research, Saint Louis University, Saint Louis, MO, USA.
• Tae Woo Park, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
• Bethany R. Pennington, Center for Perioperative Mental Health, Washington University School of Medicine, Saint Louis, MO, USA.
• Ryan M. Nunley, Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO, USA.
• Michael S. Avidan, Center for Perioperative Mental Health, Washington University School of Medicine, Saint Louis, MO, USA.
• Victoria L. Tang, Department of Medicine, University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA.
• Eric J. Lenze, Center for Perioperative Mental Health, Washington University School of Medicine, Saint Louis, MO, USA.
• Alex Gu, Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
• Kevin Y. Xu, Department of Psychiatry, Washington University School of Medicine, Saint Louis, MO, USA.

Document Type

Journal Article

Publication Date

9-15-2025

Journal

Journal of the American College of Surgeons

DOI

10.1097/XCS.0000000000001627

Keywords

18 and over; United States; aged; benzodiazepines / adverse effects*; opioid / adverse effects*; pain; postoperative / drug therapy

Abstract

BACKGROUND: Postoperative opioid and benzodiazepine use often extends beyond recovery, yet research on surgical prescribing tends to focus on opioid-naïve patients. Less is known about those already using these medications preoperatively, who face different risks and care needs. STUDY DESIGN: Using a national U.S. claims database (PearlDiver, 2010-2022), we identified insured adults receiving one 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 following surgery were assessed. Using multivariable logistic regression, we analyzed relationships between preoperative and postoperative opioid and benzodiazepine medication fills. RESULTS: Among 14.9 million adults, 62% and 80% were opioid- and benzodiazepine-naïve preoperatively. Among opioid and benzodiazepine-naïve patients, 21.4% initiated these medications postoperatively. In contrast, 51% of preoperative opioid and/or benzodiazepine users filled prescriptions after surgery. Although over 80% of patients on preoperative benzodiazepine monotherapy no longer received benzodiazepines postoperatively, benzodiazepine monotherapy strongly predicted exposure to benzodiazepine monotherapy (aOR=24.10[23.88-24.32]) and both opioid and BZDs(aOR=15.59[15.51-15.88]). CONCLUSION: 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/or benzodiazepine exposure.

APA Citation

Zhao, Amy Y.; Parel, Philip M.; Maust, Donovan T.; Sala-Rabanal, Monica; Grucza, Richard A.; Park, Tae Woo; Pennington, Bethany R.; Nunley, Ryan M.; Avidan, Michael S.; Tang, Victoria L.; Lenze, Eric J.; Gu, Alex; and Xu, Kevin Y., "Pre- and Postoperative Prescription of Opioids and Benzodiazepines in the US" (2025). GW Authored Works. Paper 7953.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/7953

Department

School of Medicine and Health Sciences Student Works