Effect of Oral Opioid Prescription on Rates of Postoperative Pain among Ophthalmology Subspecialties: A Large Database Analysis

<h2>ABSTRACT</h2><h3>Purpose</h3> To assess whether postoperative opioid prescriptions are associated with reduced pain diagnoses or emergency room (ER) visits after ophthalmic surgery. <h3>Design</h3> Retrospective cohort study using aggregated electronic health record data (June 2005-June 2025) from the TriNetX collaborative research network. <h3>Subjects</h3> Patients who underwent ophthalmic procedures across 11 subspecialty categories in the past 20 years, with or without a postoperative opioid prescription. <h3>Methods</h3> Data were analyzed using the TriNetX integrated analytics platform. Patients with chronic pain syndrome or opioid dependence were excluded. Ophthalmic procedures were identified using CPT codes, and characterized as cataract; major or minor cornea, glaucoma, oculoplastics, trauma; retina; or strabismus. Associations were assessed by calculating absolute risk differences with 95% confidence intervals (CI) and risk ratios (RR). <h3>Main Outcome Measures</h3> Diagnosis of postprocedural pain or ER visits within 2 weeks after surgery. <h3>Results</h3> The study included 2,510,984 patients. Absolute rates of postoperative pain diagnoses were low across all subspecialties. Opioid prescriptions were associated with small absolute reductions in postprocedural pain diagnoses in glaucoma major (-1.3%, 95% CI -1.4% to -1.2%, p<0.001), oculoplastics major (-0.9%, 95% CI -1.2% to -0.6%, p<0.001), cornea major (-0.8%, 95% CI -0.9% to -0.7%, p<0.001), cornea minor (-0.8%, 95% CI -0.8% to -0.7%, p<0.001), trauma major (-0.8%, 95% CI -0.9% to -0.6%, p<0.001), trauma minor (-0.7%, 95% CI -0.9% to -0.5%, p<0.001) and oculoplastics minor (-0.1%, 95% CI -0.2% to <-0.1%, p=0.008) procedures. ER visit reduction was observed only for glaucoma major procedures (-0.1%, 95% CI -0.1% to <-0.1%, p<0.001). In other subspecialties, opioid prescriptions were not associated with reduced ER utilization, and were associated with higher ER visit rates in oculoplastics, retina, and trauma major procedures. <h3>Conclusion</h3> Postoperative opioid prescriptions were associated with small absolute reductions in pain diagnoses in select subspecialties including cornea, glaucoma, oculoplastics, and trauma, but not cataract, retina, or strabismus. Opioid prescriptions offered no consistent benefit in reducing ER visits and were linked to higher ER visit rates in some subspecialties. These findings highlight the limited clinical benefit of routine opioid prescribing after many ophthalmic procedures and underscore the need for subspecialty-specific, evidence-based postoperative pain management strategies in ophthalmology.