Patterns of Postoperative Opioid Dispensing for Common Surgical Procedures Among Medicaid Beneficiaries in 2020-2021

OBJECTIVES: Inappropriate opioid prescribing to patients undergoing surgical procedures increases the risk of opioid-related adverse events. Since 2018, several opioid prescribing recommendations and guidelines have been published. We aim to examine recent patterns of procedure-specific opioid prescribing for postoperative pain during 2020-2021 in Medicaid and compare them with the findings from a 2016-2017 study.

METHODS: We used the same retrospective cross-sectional MarketScan Multi-State Medicaid database. We identified continuously enrolled non-cancer patients who had any of 24 common surgical procedures performed from October 2020 to September 2021. For each procedure, we used the same definitions as the previous study to measure 1) opioid dispensing rate following the procedure; 2) days’ supply of the opioid prescription; and 3) morphine milligram equivalent (MME) daily dose received.

RESULTS: Among 248,665 Medicaid beneficiaries with any of the 24 surgical indications (ranging from 349 to 104,882), the postoperative opioid dispensing rates ranged from 9.7% to 85.0% in 2020-2021, whereas it ranged from 30.7% to 92.1% in 2016-2017. Overall, the postoperative dispensing rates in 2020-2021 decreased in 19 surgical procedures compared to those in 2016-2017, with the greatest relative decrease in vaginal delivery from 30.7% to 9.7%. Meanwhile, postoperative dispensing for coronary artery bypass surgery had the largest relative increase from 2016-2017 to 2020-2021 (39.8% vs. 68.9%). Among all procedures, 14 and 4 procedures with mean days’ supply dispensed less than 5 days in 2020-2021 and 2016-2017, respectively. Half of the procedures had 30 or less mean daily MME in 2020-2021 whereas only one procedure had 30 or less mean daily MME in 2016-2017.

CONCLUSIONS: Among Medicaid beneficiaries, the postoperative opioid dispensing rates, days’ supply, and daily dosage in 2020-2021 decreased for most surgical procedures compared to 2016-2017. The findings potentially reflect effects of clinical guidelines on postoperative prescribing of opioids.