National trends in perioperative opioid prescription fills for inguinal hernia repair (2010-2021): a cohort study

Background

Perioperative opioid prescriptions are a crucial source of new opioid exposure. The effectiveness of legislative efforts to limit opioid prescribing remains unknown, especially after general surgery procedures.

Methods

This was a cohort study that used the MarketScan Commercial Claims and Encounters and Medicare Supplemental Databases. The study included adult beneficiaries without opioid use in the previous year who underwent ambulatory inguinal hernia repair between January 2010 and December 2021. This study examined trends in frequency and average morphine milligram equivalents (MMEs) of preoperative and postoperative opioid prescription fills among patients who underwent minimally invasive hernia repair and open hernia repair and the incidence of new persistent opioid use (NPOU). In addition, this study used the inverse probability of treatment weighting to control for confounding and weighted generalized models to assess the trends of opioid prescription fills between the 2 surgical approaches and incidence of NPOU.

Results

The study included 188,377 patients, with a median age of 52 years. Of note, 92.9% of the included patients were male. Preoperative opioid prescription fills decreased from 7.9% in 2010 to 5.4% in 2021 (P <.0001), whereas postoperative opioid prescription fills decreased from 75.7% to 72.3% (P =.14). The median MMEs per prescription fill increased over the study period (P <.0001). The incidence of NPOU was 1.0%.

Conclusion

Despite reductions in the frequency of preoperative opioid prescription fills, the average size of perioperative opioid prescription fills increased. Our findings underscore the need for enhanced opioid stewardship programs and educational initiatives to minimize opioid prescribing after inguinal hernia repair.