Association between preoperative obstructive sleep apnea diagnosis and prolonged postoperative opioid use among patients undergoing common surgical procedures.

Background: Identifying modifiable patient-related risk factors may guide interventions aimed at reducing prolonged postoperative opioid use. Obstructive sleep apnea (OSA) has been hypothesized as one such condition. However, the association between an OSA diagnosis and prolonged postoperative opioid use remains unclear.

Methods: Using administrative healthcare claims data from the MarketScan Commercial and Medicare Claims Databases, we examined the association between preoperative OSA, defined as two or more prior claims with the OSA International Classification of Diseases 10th revision (ICD-10) diagnosis code, and prolonged postoperative opioid use, defined as filling ≥10 prescriptions or ≥120 days' supply of opioids during postoperative days 91-365, using multivariable logistic regression. Our sample consisted of opioid-naïve patients undergoing 11 surgeries (total knee arthroplasty, total hip arthroplasty, appendectomy, cholecystectomy, operative management of small bowel obstruction, diverticulitis, hernia, gonadal torsion, ectopic pregnancy, and aortic aneurysm) between 2016 and 2021.

Results: Our final sample included 270 320 patients with a mean age of 49.58; 29 095 (10.8%) had a diagnosis of OSA. The unadjusted incidence of prolonged postoperative opioid use was 0.6% (95% CI 0.5 to 0.7) for patients with OSA versus 0.4% (95% CI 0.4 to 0.4) for those without OSA. After adjusting for confounders, the incidence was 0.4% for both groups (difference 0.0%, 95% CI -0.1 to 0.0, p=0.184). Results were robust to alternate specifications of outcome, exposure, and cohort.

Conclusions: A preoperative OSA diagnosis was not associated with a change in the risk of prolonged postoperative opioid use across common surgical procedures, suggesting that a preoperative OSA diagnosis may not be a modifiable risk factor impacting prolonged postoperative opioid use.