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

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.

Department

School of Medicine and Health Sciences Student Works

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