Association of Preoperative Depression and Anxiety With Long-term Opioid Use After Hysterectomy for Benign Indications

Obstet Gynecol. 2021 Nov 1;138(5):715-724. doi: 10.1097/AOG.0000000000004568.


Objective: To assess whether preoperative depression or anxiety is associated with increased risk of long-term, postoperative opioid use after hysterectomy among women who are opioid-naïve.

Methods: We conducted an observational cohort study of 289,233 opioid-naïve adult women (18 years or older) undergoing hysterectomy for benign indications from 2010 to 2017 using IBM MarketScan databases. Opioid use and refills in the 180 days after surgery and preoperative depression and anxiety were assessed. Secondary outcomes included 30-day incidence of emergency department visits, readmission, and 180-day incidence of opioid complications. The association of depression and anxiety were compared using inverse-probability of treatment weighted log-binomial and proportional Cox regression.

Results: Twenty-one percent of women had preoperative depression or anxiety, and 82% of the entire cohort had a perioperative opioid fill (16% before surgery, 66% after surgery). Although perioperative opioid fills were relatively similar across the two groups (risk ratio [RR] 1.07, 95% CI 1.06-1.07), women with depression or anxiety were significantly more likely to have a postoperative opioid fill at every studied time period (RRs 1.44-1.50). Differences were greater when restricted to persistent use (RRs 1.49-2.61). Although opioid complications were rare, women with depression were substantially more likely to be diagnosed with opioid dependence (hazard ratio [HR] 5.54, 95% CI 4.12-7.44), and opioid use disorder (HR 4.20, 95% CI 1.97-8.96).

Conclusion: Perioperative opioid fills are common after hysterectomy. Women with preoperative anxiety and depression are more likely to experience persistent use and opioid-related complications.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adult
  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / therapeutic use
  • Anxiety / epidemiology*
  • Cohort Studies
  • Depression / epidemiology*
  • Drug Prescriptions / statistics & numerical data
  • Female
  • Humans
  • Hysterectomy / adverse effects*
  • Hysterectomy / statistics & numerical data
  • Middle Aged
  • Opioid-Related Disorders / epidemiology*
  • Opioid-Related Disorders / etiology
  • Pain, Postoperative / drug therapy
  • Postoperative Complications / epidemiology
  • Postoperative Complications / etiology


  • Analgesics, Opioid