To describe the secular trends in utilization of intraoperative neurophysiology monitoring (IONM).Retrospective descriptive study of a large claims database of privately-insured patients in the USA during the period 2006-2022.Among 3917 cerebellopontine angle tumor resections in 3779 patients [median (p25-p75) age: 49 (38-56) years, 59 % females], 910 (23.2 %) had both brainstem auditory evoked potentials (BAEP) and cranial nerve monitoring. Among 36,392 carotid endarterectomies in 33,017 patients [60 (56-62) years, 40 % females], 1676 (4.6 %) had both electroencephalogram (EEG) and somatosensory evoked potentials (SSEP) monitoring. Among 26,131 spinal fusion surgeries in 24,741 patients [15 (13-23) years, 68 % females], 9080 (34.8 %) had SSEP, motor evoked potentials (MEP), and electromyogram (EMG) monitoring. Among 5193 tethered cord release surgeries in 4976 patients [8 (2-17) years, 59 % females], 324 (6.2 %) had SSEP, MEP, EMG, and sphincter EMG monitoring. Among 5105 thoracoabdominal aortic repair surgeries in 4764 patients [58 (50-62) years, 26 % female], 187 (3.7 %) had both SSEP and MEP monitoring. On multivariable analysis, factors associated with receiving intraoperative neurophysiology monitoring included recency of surgery, urban residence, employment type, and certain USA regions. The proportion of surgeries with IONM tended to increase over the period 2006-2022.Only a minority of surgeries in which IONM is indicated had IONM. The proportion of surgeries with IONM tended to increase in 2006-2022.