• Sudharsan Srinivasan, Vidhya Gunaseelan, Alexandra Jankulov, Kao-Ping Chua, Michael Englesbe, Jennifer Waljee, Mark Bicket, and Chad M Brummett.
• Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
• Ann. Surg. 2023 Dec 1; 278 (6): e1185e1191e1185-e1191.

ObjectiveTo assess whether the risk of persistent opioid use after surgery varies by payer type.BackgroundPersistent opioid use is associated with increased health care utilization and risk of opioid use disorder, opioid overdose, and mortality. Most research assessing the risk of persistent opioid use has focused on privately insured patients. Whether this risk varies by payer type is poorly understood.MethodsThis cross-sectional analysis of the Michigan Surgical Quality Collaborative database examined adults aged 18 to 64 years undergoing surgical procedures across 70 hospitals between January 1, 2017 and October 31, 2019. The primary outcome was persistent opioid use, defined a priori as 1+ opioid prescription fulfillment at (1) an additional opioid prescription fulfillment after an initial postoperative fulfillment in the perioperative period or at least 1 fulfillment in the 4 to 90 days after discharge and (2) at least 1 opioid prescription fulfillment in the 91 to 180 days after discharge. The association between this outcome and payer type was evaluated using logistic regression, adjusting for patient and procedure characteristics.ResultsAmong 40,071 patients included, the mean age was 45.3 years (SD 12.3), 24,853 (62%) were female, 9430 (23.5%) were Medicaid-insured, 26,760 (66.8%) were privately insured, and 3889 (9.7%) were covered by other payer types. The rate of POU was 11.5% and 5.6% for Medicaid-insured and privately insured patients, respectively (average marginal effect for Medicaid: 2.9% (95% CI 2.3%-3.6%)).ConclusionsPersistent opioid use remains common among individuals undergoing surgery and higher among patients with Medicaid insurance. Strategies to optimize postoperative recovery should focus on adequate pain management for all patients and consider tailored pathways for those at risk.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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