• Reg Anesth Pain Med · Jan 2025

    Impact of preoperative opioid exposure on cost of care and workplace productivity loss after elective surgery.

    • Christina Lynn Shabet, Dominic Alessio, Brooke Kenney, Mark C Bicket, Chad M Brummett, and Jennifer F Waljee.
    • Section of Plastic Surgery, University of Michigan Department of Surgery, Ann Arbor, Michigan, USA cshabet@umich.edu.
    • Reg Anesth Pain Med. 2025 Jan 31.

    IntroductionA high proportion of surgical patients has previous opioid exposure, which is associated with poorer recovery and increased morbidity. However, much less is known regarding the direct and indirect costs that are associated with healthcare utilization among individuals on preoperative opioid therapy.MethodsWe analyzed The Merative MarketScan Commercial Database linked with the Merative MarketScan Health and Productivity Management Database to include all adult patients admitted and discharged from common elective surgeries between January 1, 2018 and June 30, 2021. Patients were clustered by preoperative opioid exposure and estimates for total direct payments (in USD) generated and workplace absenteeism were assessed for a 6-month period.Results10 737 patients were included in our cohort; 17.0% classified as 'low' preoperative opioid use (median oral morphine equivalents (IQR)=126 (75-225)), 5.0% as 'medium' (370 (225-640)) and 3.0% as 'high' (4500 (2120-10 908)). Compared with opioid naive or low preoperative use, individuals with high preoperative use had significantly higher estimated payments for care at 6 months ($4212 for high vs $2706 for naive (p=0.007) and $3059 for low (p=0.045)), while utilizing increased ambulatory care including clinic and outpatient visits after surgery. There was no significant difference in workplace absenteeism between groups.ConclusionHigh preoperative opioid use is associated with increased healthcare utilization and costs following common elective surgery. Future efforts should focus on this patient population to explore interventions that could optimize value-based care by improving outcomes and reducing costs.© American Society of Regional Anesthesia & Pain Medicine 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.

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