Perioperative opioid prescribing after male fertility procedures is associated with new persistent opioid use: retrospective analysis of a large claims database

Objective: To assess the risk of new persistent opioid use in opioid-naïve men who underwent male fertility procedures. Design: Retrospective cohort study using a claims database. Setting: A database linking electronic medical record data and claims—assessing men who underwent fertility procedures between 2010 and 2021. Patient(s): Opioid-naïve men who underwent fertility procedures (open or laparoscopic varicocelectomy, spermatocele excision, and testicular excisional or incisional biopsy) without further surgical intervention requiring anesthesia in the 2 years after the index procedure. Those with and without perioperative opioid prescriptions were propensity score matched on age, race/ethnicity, smoking status, mental health diagnoses, and preoperative pain diagnoses. Intervention(s): Perioperative opioid prescription. Main Outcome Measure(s): The primary outcome was the incidence of new persistent opioid use (opioid prescription 3–9 months after the index fertility procedure). The secondary outcome was prolonged opioid use (opioid prescription 9–24 months after the index fertility procedure). Result(s): A total of 387,565 men who underwent fertility procedures were identified, of whom 25.1% received an opioid prescription. After propensity score matching, 97,215 men were included; 4.7% of men who received a perioperative opioid prescription developed new persistent opioid use compared with 2.2% of those without a perioperative opioid prescription (risk ratio, 2.16; 95% confidence interval, 2.05–2.27; number needed to harm, 39). When assessing each unique fertility procedure independently, men who received perioperative opioids had statistically higher odds of developing new persistent opioid use for all procedure types. Men with new persistent opioid use were much more likely to go on and develop prolonged opioid use than men without new persistent opioid use. Conclusion(s): Opioid prescription after male fertility procedures is associated with a significant risk of new persistent opioid use, emphasizing the importance of judicious opioid prescribing for male fertility procedures.