Association Between Opioid Use Disorder and Hysterectomy Outcomes.

Authors

Stephanie L Lim, Natalie Wickenheisser, Tracy Truong, Shakthi Unnithan, Arleen Song, Amy Broach, Craig Sobolewski, Evan Myers

Published in

Obstetrics and gynecology. Aug 06, 2026. Epub Aug 06, 2026.

Abstract

To evaluate the associations between opioid use disorder (OUD) and complications, length of stay, and costs of hysterectomy.
This retrospective cohort study evaluated patients with and without OUD who were aged 18 years or older and underwent hysterectomy. The Nationwide Ambulatory Surgery Sample and National Inpatient Sample databases were queried from 2016 to 2021 for outpatient and inpatient hysterectomies for benign and malignant indications. Open, laparoscopic, robotic, and vaginal hysterectomies were included. Current Procedural Terminology codes and International Classification of Diseases, Tenth Revision codes were used to identify patients with OUD within these cohorts. The primary outcome was composite postoperative complications, analyzed using a survey-weighted modified Poisson regression model. Secondary outcomes included length of stay and hospital charges (adjusted to 2024 U.S. dollars), analyzed using survey-weighted negative binomial and gamma models. All models were adjusted for demographics and comorbidities.
Data were included for 1,695,075 patients who underwent outpatient surgery and 188,178 patients who underwent inpatient surgery, corresponding to national estimates of 2,292,869 patients who underwent outpatient surgery and 934,789 patients who underwent inpatient surgery. For the outpatient cohort, 21,632 (0.9%) had OUD. The mean age was 48.5 years; 68.6% of the surgeries took place in urban teaching hospitals. Among these patients, 1.4% underwent abdominal hysterectomy, and 9.3% underwent hysterectomy for malignant indications. Patients with OUD had a composite complication rate of 3.8%, and those without OUD had a composite complication rate of 3.4% (adjusted rate ratio [RR] 1.13; 95% CI, 1.00-1.28). Mean charges were $48,027 and $50,297, respectively (adjusted incidence risk ratio [IRR] 0.96; 95% CI, 0.91-1.01). For the inpatient cohort, 12,085 (1.3%) had OUD. The overall mean age was 50.6 years; most hospitals were urban teaching hospitals (74.7%). Among these patients, 73.4% underwent abdominal hysterectomy and 18.2% underwent hysterectomy for malignant indications. Patients with OUD had a composite complication rate of 14.7%, and those without OUD had a composite complication rate of 11.8% (adjusted RR 1.18; 95% CI, 1.07-1.31). Patients with OUD were admitted for a mean of 4.3 days, compared with 3.2 days for those without OUD (adjusted IRR 1.32; 95% CI, 1.24-1.41). Mean charges were $91,258 and $71,809, respectively (adjusted IRR 1.22; 95% CI, 1.16-1.29).
This study suggests that patients with OUD are at higher risk of complication after outpatient and inpatient hysterectomies than patients without OUD. Opioid use disorder was also associated with a longer length of stay and increased hospital charges for those who underwent inpatient hysterectomy. These patients may benefit from additional preoperative optimization and education.

PMID:
42561417
Bibliographic data and abstract were imported from PubMed on 07 Aug 2026.

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