Authors: Bicket MC et al.
Source: Anesthesiology. 144(2):431–440, February 2026. DOI: 10.1097/ALN.0000000000005771
Summary:
In this large national cohort study, Bicket and colleagues evaluated trends in the use of medications for opioid use disorder (MOUD) among commercially insured U.S. surgical patients between 2016 and 2022. The authors sought to clarify whether the prevalence of MOUD use in surgical populations is increasing and to identify procedure types with the highest rates of MOUD exposure—an increasingly important issue given the lack of clear perioperative pain management guidelines for these patients.
Using the Merative MarketScan Commercial Database, the investigators analyzed more than 8.1 million surgical admissions involving over 5 million adults aged 18–64 years across 1,083 major surgical procedures. MOUD use was defined as receipt of treatment within 1 to 180 days prior to surgery. Logistic regression models adjusted for demographics and comorbidities were used to assess annual trends, and procedure-specific prevalence rates were calculated.
The adjusted prevalence of MOUD use nearly doubled over the study period, rising from 55.2 per 100,000 procedures in 2016 to 99.8 per 100,000 procedures in 2022. This increase was consistent and statistically significant after adjustment, reflecting a steady growth in the number of surgical patients receiving MOUD. Among patients using MOUD, buprenorphine overwhelmingly predominated, accounting for 84% of cases.
MOUD use was not evenly distributed across surgical categories. The highest prevalence was observed in debridement procedures, shoulder arthroplasty, lower extremity amputation, and open fracture repair of the hip or pelvis—procedures frequently associated with trauma, chronic pain, infection, or advanced comorbidity. These findings emphasize that anesthesiologists and surgeons in orthopedic and trauma settings are especially likely to encounter patients actively treated for opioid use disorder.
The authors conclude that the growing prevalence of MOUD use among surgical patients underscores the urgent need for evidence-based perioperative pain management guidelines. Without standardized approaches, clinicians risk undertreating pain, precipitating withdrawal, or disrupting continuity of opioid use disorder treatment during the perioperative period.
What You Should Know:
The number of surgical patients receiving medications for opioid use disorder is increasing steadily, even among privately insured populations. Buprenorphine now dominates MOUD use in surgical patients, and orthopedic and trauma-related procedures have the highest prevalence.
Key Points:
MOUD use among commercially insured surgical patients nearly doubled from 2016 to 2022.
Buprenorphine accounted for more than four out of five MOUD cases.
Highest MOUD prevalence was seen in debridement, orthopedic reconstruction, and amputation procedures.
These trends highlight the need for clear perioperative pain and MOUD management guidelines, particularly in orthopedic surgery.
Thank you to Anesthesiology for publishing this timely analysis clarifying how opioid use disorder treatment is increasingly intersecting with perioperative care.