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

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BACKGROUND: This study evaluates the risk of persistent opioid use (POU) among thyroidectomy patients given postoperative opioids. METHODS: 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. RESULTS: 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. CONCLUSION: Post-thyroidectomy opioid prescription modestly increases POU risk, highlighting the need for careful patient counseling and judicious use.

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