Preoperative Opioid or Benzodiazepine Use Predicts 1-to-3 Month Postoperative Prescribing

Zhao AY, Parel PM, Maust DT,  et al. Pre- and Postoperative Prescription of Opioids and Benzodiazepines in the US. J Am Coll Surg. September 15, 2025.

National claims data from 2010–2022 covering 14.9 million adults who underwent one of 18 common operations were analyzed in a retrospective cohort study to examine patterns of filled prescriptions for opioids and benzodiazepines (BZD) before and after surgery.

Preoperative exposure was defined by filled prescriptions during the 6 months to 7 days before surgery and categorized as opioid only, BZD only, both, or neither. The primary outcome was any opioid or BZD prescription filled between postoperative days 31 and 90. Multivariable logistic models adjusted for age, sex, procedure type, and Charlson Comorbidity Index.

Preoperative exposure was the strongest predictor of prescribing in the 1–3-month window: approximately 21% of preop-naïve patients filled either medication compared to about 51% among those with any preop exposure. The association was most pronounced after joint arthroplasty and spine surgery and less marked after routine general surgery (e.g., cholecystectomy, appendectomy).

For surgeons, the perioperative plan should consider that most extended postoperative prescriptions reflect continuation of preexisting therapy rather than new surgical need. Surgeons should aim to incorporate preop medication reconciliation into clinic workflows, coordinate with longitudinal prescribers on taper/bridging plans (especially in musculoskeletal/spine cases where continuation is common), and avoid co-prescribing opioids and BZDs when reasonable alternatives exist.