Authors: Bicket M.C. et al.
Anesthesiology, September 25, 2025. DOI: 10.1097/ALN.0000000000005771
This large national cohort study evaluated trends in the use of medications for opioid use disorder (MOUD) among commercially insured adults undergoing major surgical procedures in the United States between 2016 and 2022. As the number of surgical patients treated with MOUD continues to rise, anesthesiologists face growing challenges in perioperative pain management and opioid stewardship.
Using data from the Merative MarketScan Commercial Database, which includes 22–28 million privately insured patients annually, investigators identified 8.1 million surgical admissions corresponding to 5 million unique adults aged 18–64 years across 1,083 major procedure types. The analysis examined MOUD use within 180 days before surgery, including buprenorphine, methadone, and naltrexone, with adjustments for demographics and comorbidities.
The adjusted prevalence of MOUD use nearly doubled over the study period, from 55.2 per 100,000 surgeries in 2016 to 99.8 per 100,000 in 2022, representing an average annual increase of 16.9 per 100,000 (95% CI, 14.0–19.8). Buprenorphine was the dominant therapy, accounting for 84% of all MOUD prescriptions. The highest procedure-specific MOUD rates were seen in debridement (719 per 100,000 procedures), shoulder arthroplasty (579), lower extremity amputation (530), and hip or pelvic fracture repair (498).
These results show that the population of surgical patients on MOUD has grown substantially, especially in orthopedic and trauma settings. The findings underscore the urgent need for clear, evidence-based perioperative management guidelines to balance effective analgesia with relapse prevention and continued MOUD adherence.
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 perioperative MOUD use.
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Procedures with the highest MOUD prevalence were largely orthopedic or trauma-related.
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The findings highlight the need for multidisciplinary perioperative care strategies and standardized guidelines for patients on MOUD.
Thank you to Anesthesiology for publishing this important population-level study documenting rising perioperative MOUD use and emphasizing the need for updated clinical guidance.