Journal
ANNALS OF SURGERY
Volume 265, Issue 4, Pages 715-721Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/SLA.0000000000002117
Keywords
costs; discharge; length of stay; morbidity; narcotic; opioid; readmission; surgery
Categories
Funding
- Mentored Clinical Investigator Award through the Agency for Healthcare Research and Quality [1K08HS023313-01]
- Agency for Healthcare Research and Quality [K08 1K08HS023313-01]
- American College of Surgeons
- American Foundation for Surgery of the Hand
- National Institutes of Health
- University of Michigan Medical School Dean's Office (Michigan Genomics Initiative)
- Neuros Medical Inc. (Willoughby Hills, OH)
- NIAMS [R01 AR060392]
- NIDA [1R01DA038261-01A1]
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Objective: To examine the extent to which preoperative opioid use is correlated with healthcare utilization and costs following elective surgical procedures. Summary Background Data: Morbidity and mortality associated with prescription opioid use is escalating in the United States. The extent to which chronic opioid use influences postoperative outcomes following elective surgery is not well understood. Methods: Truven Health Marketscan Databases were used to identify adult patients who underwent elective abdominal surgery between June 2009 and December 2012 (n = 200,005). Generalized linear regression was used to determine the effect of preoperative opioid use on postoperative healthcare utilization (length of stay, 30-d readmission, and discharge destination) and cost (hospital stay, 90-, 180-, and 365-d) after adjusting for number of comorbidities, psychological conditions, and demographic characteristics. Results: In this cohort, 8.8% of patients used opioids preoperatively. Compared with non-users, patients using opioids preoperatively were more likely to have a longer hospital stay (2.9 d vs. 2.5 d, P < 0.001) and were more likely to be discharged to a rehabilitation facility (3.6% vs. 2.5%, P < 0.001), adjusting for covariates. Preoperative opioid use was also correlated with a greater rate of 30-day readmission (4.5% vs. 3.6%, P < 0.001) and overall greater expenditures at 90- ($12036.60 vs. $3863.40, P < 0.001), 180($16973.70 vs. $6790.60, P < 0.001), and 365- ($25495.70 vs. $12113.80, P < 0.001) days following surgery, adjusted for covariates. Additionally, dose-effects were observed regarding readmission, discharge destination, and late healthcare expenditures. Conclusions: Preoperative interventions focused on opioid cessation and alternative analgesics may improve the safety and efficiency of elective surgery among chronic opioid users.
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