Perioperative Opioid Prescribing Following Male Fertility Procedure are 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 undergoing male fertility procedures DESIGN: Retrospective cohort study using a claims database SETTING: TriNetX Diamond Network - a database linking electronic medical record data and claims - assessing men undergoing fertility procedure between 2010 and 2021.

SUBJECTS: Opioid-naïve men undergoing fertility procedures (open or laparoscopic varicocelectomy, spermatocele excision, testicular excisional or incisional biopsy) without further surgical intervention requiring anesthesia in the two 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.

EXPOSURE: Perioperative opioid prescription MAIN OUTCOME: Incidence of new persistent opioid use (opioid prescription 3 to 9 months after index fertility procedure). Secondary outcome was prolonged opioid use (opioid prescription 9 to 24 months after index fertility procedure).

RESULTS: 387,565 men undergoing 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 men without a perioperative opioid prescription (RR 2.16, 95% CI 2.05-2.27, Number Needed to Harm 39). When assessing each unique fertility procedure independently, men receiving 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 compared to men without new persistent opioid use.

CONCLUSION: Opioid prescription after male fertility procedures is associated with significant risk of new persistent opioid use, emphasizing the importance of judicious opioid prescribing for male fertility procedures.