No abstract

Importance 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. Objective To examine the extent to which preoperative opioid use is correlated with healthcare utilization and costs following elective surgical procedures. Design Truven Health Marketscan® Databases were used to identify patients. Setting Outpatient services claims from patients who underwent elective procedure requiring an inpatient stay. Participants Patients ages 18 and older who underwent elective hysterectomy, bariatric surgery, reflux procedures, and ventral hernia repair between 2009 and 2013 (n=184,053). Exposure Receipt of prescription opioid analgesic within 30 days of and 30 to 90 days prior to procedure. Preoperative opioid use was drawn from insurance claims and converted into oral morphine equivalents (OMEs). Main Outcomes and Measures Outcomes included postoperative healthcare utilization (length of stay, 30-day readmission rate, discharge destination) and cost (hospital stay, 90-, 180-, and 365-day). We used generalized linear regression to determine the effect of preoperative opioid use on healthcare utilization and cost outcomes after adjusting for number of comorbidities, psychological conditions, and demographic characteristics. Results In this cohort, 10.0% of patients used opioids preoperatively. Compared with non-users, patients using opioids preoperatively were more likely to have a longer and more expensive hospital stay (2.8 days vs. 2.5 days, p<0.001; $21,919.00 vs. $21,241.80, p = 0.02, respectively) and were more likely to be discharged to a rehabilitation facility (3.5% vs. 2.4%, p<0.001), adjusting for covariates. Preoperative opioid use was also correlated with a greater rate of 30-day readmission (3.7% vs. 3.1%, p<0.001) and overall greater expenditures at 90- ($5,405.40 vs. $3,681.70, p<0.001), 180- ($10,148.20 vs. $6,469.80, p<0.001), and 365-($19,695.60 vs. $11,419.40, p<0.001) days following surgery, adjusted for covariates. Conclusions and Relevance Preoperative opioid use is an independent risk factor for longer length of stay, higher 30-day readmission rates and probability of being discharged to a rehabilitation facility, and greater costs in the postoperative period. Preoperative interventions focused on opioid cessation and alternative analgesics may improve the safety and efficiency of elective surgery among chronic opioid users.

Background The misuse of opioid analgesics is a major public health concern, and guidelines regarding postoperative opioid use are sparse. We examined the use of opioids following outpatient upper extremity procedures. We hypothesized that opioid use varies widely by procedure and patient factors. Methods We studied opioid prescriptions among 296,452 adults ages ≥ 18 years who underwent carpal tunnel release, trigger finger release, cubital tunnel release, and thumb carpometacarpal (CMC) arthroplasty from 2009 to 2013. We analyzed insurance claims drawn using Truven Health MarketScan Commercial Claims and Encounters, which encompasses over 100 health plans in the United States. Using multivariable regression, we compared the receipt of opioids, number of days supplied, indicators of inappropriate prescriptions, and number of refills by patient factors. Results In this cohort, 59% filled a postoperative prescription for opioid medication, and 8.8% patients had an indicator of inappropriate prescribing. The probability of filling an opioid prescription declined linearly with advancing age. In multivariate analysis, patients who had previously received opioids were more likely to fill a postoperative opioid prescription (66% vs. 59%), receive longer prescriptions (24 vs. 5 days), receive refills following surgery (24% vs. 5%), and have at least one indicator of potentially inappropriate prescribing (19% vs 6%). Conclusions Current opioid users are more likely to require postoperative opioid analgesics for routine procedures, and more likely to receive inappropriate prescriptions. More evidence is needed to identify patients who derive the greatest benefit from opioids in order to curb opioids prescriptions when alternative analgesics may be equally effective and available.