Association of Socioeconomic and Psychiatric Factors with Postoperative Opioid Use Disorder: A Retrospective Cohort Analysis

Background: The opioid overdose epidemic continues as a serious world problem, with postoperative opioid prescribing recognized as a critical contributor to opioid use disorder (OUD) development. Identifying risk factors associated with OUD in the perioperative setting is essential for developing targeted prevention strategies. This study aimed to evaluate the association of social determinants of health (SDoHs) and mental health conditions in predicting OUD within 1 year following surgery. Methods: This retrospective cohort study used de-identified electronic health records from the TriNetX Research Network, evaluating over 295 000 matched patients across individual risk factor cohorts. The index event was defined as the first opioid exposure within 3 days after their first surgery. Patients with and without risk factors were propensity score matched and then odds ratios (ORs) and absolute risks were calculated for postoperative OUD within 1 year. Results: Significance at P < .001 was present for all SDoHs assessed with individual ORs ranging from 0.77 (benzodiazepine use, n = 3 026 362) to 8.3 (homelessness, n = 16 997). A cohort with known mixed risk factors showed an additive association with OUD risk. A validation cohort confirmed the methodology, showing no association between levothyroxine use and OUD development (OR 1.0, P = .416, n = 222 471). The definition of OUD in this study was based on ICD-10 coding, which does not perfectly align with DSM-5 diagnostic criteria and may capture patients with persistent opioid use but without formal OUD diagnosis. Conclusions: Key SDoHs and mental health conditions significantly increase the risk of postoperative OUD. These findings underscore the need for preoperative risk stratification and targeted interventions, including multimodal analgesia and integrated mental health care to mitigate OUD risk in surgical populations. Addressing these factors is critical for advancing perioperative care and combating the opioid overdose crisis.