Post-Thyroidectomy Opioid Prescription and Risk of Persistent Opioid Use: A Propensity Matched Cohort Study.

Abstract

This study evaluates the risk of persistent opioid use (POU) among thyroidectomy patients given postoperative opioids. Patients undergoing thyroidectomy were identified using the TriNetX Research Platform (2010-2024). Cohorts were divided based on opioid prescriptions on the day of surgery. With propensity score matching to prevent confounding bias, risk ratios were calculated for opioid prescriptions 3-9 months post-surgery. Secondary outcomes included ED presentation, pain diagnosis, and lifetime risk of opioid use disorder, defined as significant social dysfunction due to uncontrolled use. The post-match opioid group (n = 19,727) experienced a 4.61% risk of POU (control: 4.07%), representing a 14% higher risk of POU compared to the non-opioid group (RR 1.14, 95% CI: [1.03, 1.25]). Opioids slightly decreased the likelihood of outpatient visits at 30 days (RR: 0.97 [0.95, 0.98]) and 90 days (RR: 0.96 [0.94, 0.97]) following surgery. There were no significant differences in ED presentation, pain diagnoses at 30 and 90 days, or lifetime OUD risk. Post-thyroidectomy opioid prescription modestly increases POU risk, highlighting the need for careful patient counseling and judicious use.