Documented Mental Health Disorders and Long-Term Opioid Therapy After Hospital Discharge in a Predominantly Cardiothoracic Surgical Cohort

Background/Objectives: We evaluated the association of documented mental health disorders with long-term opioid therapy (LTOT) after hospital discharge in predominantly cardiothoracic surgical RightRx participants. Methods: The retrospective cohort included 999 patients newly prescribed an opioid at discharge. The 15-category administrative definition was checked against patient-level diagnosis records, and two erroneous code mappings were corrected. The corrected mental health composite identified 153 patients. LTOT was defined as ≥90 cumulative modeled days supplied within discharge days 0–179. Adjusted Firth regression included age, sex, and trial arm. Results: Four patients were reclassified from the original 157-person mental health group; none met LTOT. LTOT occurred in 14/999 (1.4%): 2/153 (1.31%) with and 12/846 (1.42%) without a corrected documented mental health disorder (adjusted OR 1.07, 95% CI 0.20–3.73; risk difference −0.11 percentage points, 95% CI −1.52 to 3.28). The adjusted opioid fill-rate ratio was 1.51 (95% CI 1.27–1.79), attenuating to 1.14 (95% CI 0.97–1.35) after removal of two extreme fill counts. A distinct late-dispensing outcome (≥1 eligible opioid fill on days 90–179) occurred in 89 patients (adjusted OR 1.42, 95% CI 0.80–2.41). Conclusions: LTOT was rare, and the confidence interval remains compatible with clinically important associations. Coding corrections did not materially alter the principal interpretation. The fill-frequency finding is upper-tail-sensitive and exploratory. Incomplete longitudinal pharmacy eligibility and predominantly surgical case mix limit inference.