Treatment gaps for opioid use disorder among commercially insured US surgical patients, 2016–2022

Background Despite clear evidence of treatment gaps for opioid use disorder (OUD) among the general population, diagnosis and treatment patterns among surgical patients remain poorly characterized. This study aimed to examine national trends in OUD diagnosis and exposure to treatment with medications for opioid use disorder (MOUD) among US surgical patients. Methods This population-based cohort study used the Merative MarketScan Commercial Database from July 1, 2016 to December 31, 2022. US adults aged 18–64 years undergoing inpatient or outpatient surgery were included. OUD was identified using International Classification of Disease, 10th Revision codes. MOUD receipt was defined as 1+pharmacy or medical claims for buprenorphine, methadone, or naltrexone within 180 days before surgery. Multivariate logistic regression assessed trends in OUD and MOUD receipt, adjusting for patient, surgical, and clinical variables. Results Among 5 341 768 surgical patients (62.5% female), 31 094 (0.58%) had an OUD diagnosis. The prevalence of OUD declined from 0.71% in 2016 to 0.50% in 2022. Among patients with OUD, the proportion receiving MOUD in the 6 months before surgery increased from 17.8% to 32.6% over the study period. The corresponding treatment gap in MOUD receipt decreased from 82.2% in 2016 to 67.4% in 2022. Conclusions In this national cohort of commercially insured surgical patients, most individuals diagnosed with OUD did not receive evidence-based treatment before surgery, despite modest improvements over time. These findings highlight a persistent treatment gap and suggest missed opportunities to improve perioperative care and outcomes for patients with OUD.