Authors: Bicket et al.
Anesthesiology, September 25, 2025. DOI: 10.1097/ALN.0000000000005771
This national cohort study examined the prevalence and trends of medication use for opioid use disorder (MOUD) among privately insured U.S. adults undergoing major surgical procedures between 2016 and 2022. Using the Merative MarketScan Commercial Database—which captures claims from 22 to 28 million insured patients annually—the authors analyzed over 8.1 million surgical admissions to identify how often MOUDs were used before surgery and which procedures had the highest prevalence.
The findings revealed a striking increase in MOUD use over time: from 55.2 per 100,000 procedures in 2016 to 99.8 per 100,000 in 2022. Buprenorphine was the dominant therapy, accounting for 84% of MOUD prescriptions. The highest rates of MOUD use were seen in patients undergoing debridement, shoulder arthroplasty, lower extremity amputation, and hip or pelvis open fracture repair—highlighting the significant overlap between opioid dependence and orthopedic surgery.
The study underscores a growing need for clear, evidence-based perioperative pain management guidelines tailored to patients receiving MOUD, particularly as their numbers continue to rise in surgical populations.
What You Should Know
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MOUD use among surgical patients nearly doubled from 2016 to 2022.
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Buprenorphine accounted for the vast majority of MOUD prescriptions.
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Orthopedic procedures—especially debridement and arthroplasty—showed the highest prevalence.
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The increasing prevalence signals an urgent need for standardized perioperative care guidelines for patients on MOUD.
References
Huxtable CA et al. Acute pain management in opioid-tolerant patients: A growing challenge. Anaesth Intensive Care. 2011;39(5):804–823.
Chou R et al. Management of opioid use disorder in surgical settings. JAMA. 2020;324(16):1668–1679.
Thank you to Anesthesiology for publishing this important analysis on perioperative opioid use disorder management.