Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System

Shafi, Shahid; Collinsworth, Ashley; Copeland, Laurel A.; Ogola, Gerald; Qiu, Taoran; Kouznetsova, Maria; Liao, I‐Chia; Mears, Natalie; Pham, An; Wan, George J.; Masica, Andrew L.

doi:10.1001/jamasurg.2018.1039

Cited by 174 publications

(170 citation statements)

References 22 publications

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“…creases in clinical outcomes and overall healthcare utilisation associated with prescription opioid use, in particular the disproportionate increased risk among persons with CLD. Our findings validate the association of opioid use and higher rates of admission and overall mortality found in prior, small single centre retrospective studies and in larger database studies of the general population 7,10,20,21. In our study, individuals with CLD and opioid prescriptions had a 2.5 times increased risk of hospitalisation and a 1.95 times increased risk of in-hospital mortality compared to individuals without CLD with opioid prescriptions.…”

supporting

confidence: 90%

Prescription opioid use is common and associated with worse clinical outcomes in individuals with chronic liver disease

et al. 2020

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Summary Background Prescription opioid use is highly prevalent and associated with increased morbidity and mortality. Clinical implications of use in chronic liver disease(CLD) remains poorly characterised. Aims Assess prevalence and clinical impact of opioid use in patients with CLD. Methods We conducted a retrospective cohort study using Marketscan to compare correlates and clinical outcomes of opioid use among patients with and without CLD. Patients were classified into categories based on opioid prescription claims in the 12‐month period prior to index: non‐use, naïve‐use and prior‐use. Multivariable logistic regression and Cox regression with a time‐dependent covariate were used to assess correlates of opioid use and clinical outcomes including index hospitalisation, total admissions, hospital days, cost of hospitalisation and in‐hospital mortality. Results Over a median follow‐up of 38 (IQR 25‐54) months among 587 445 adults (n = 71 402 CLD and 516 043 non‐CLD), prescription opioid use (naïve‐use and prior‐use) was significantly higher among CLD than non‐CLD patients (60% vs 41.8%, P < .001). Opioid exposure increased risk of clinical outcomes in both CLD and non‐CLD patients (admissions IRR 2.71, 95% CI 2.67‐2.76; hospital days IRR 3.00,95% CI 2.93‐3.08; total cost IRR 3.13, 95% CI, 2.97‐3.31; in‐hospital mortality IRR 5.80, 95% CI 5.17‐6.50). Associations between opiate use and clinical outcomes were greater among CLD than non‐CLD patients (interaction P < .05 in each model). Conclusions Prescription opioid use is higher among patients with CLD and associated with higher rates, duration and cost of hospitalisation and in‐hospital mortality. Interventions to curb opioid use in CLD are needed to improve healthcare utilisation and clinical outcomes.

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supporting

confidence: 90%

Prescription opioid use is common and associated with worse clinical outcomes in individuals with chronic liver disease

et al. 2020

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“…In a study of 135,379 surgical patients having a wide variety of procedures and endoscopy, inpatient opioid use resulted in 11%e14% ORAE and was associated with increased inpatient mortality, an increase in hospital length of stay (LOS), higher 30-day readmission rate, and an $8225 increase in hospital episode cost. 14 Another study found that patients who were prescribed opioids after low-risk surgery were 44% more likely to receive opioids one year postoperatively compared to those not receiving opioids. 23 Though opioid-prescribing patterns are likely to vary among hospitals and surgeons, we found that the MIS approach in sigmoid resection reduced both the dose of opioids received and the duration of combined opioid use (parenteral and/ or oral) in the perioperative period.…”

Section: Discussionmentioning

confidence: 99%

“…12 Approximately 10% of patients undergoing surgery develop opioid-related adverse events (ORAE) that are associated with increase inpatient mortality, prolonged length of stay, increased cost of hospitalization, and higher readmission rates. 13,14 Patients undergoing gastrointestinal surgery have moderate to severe pain and are at higher risk for prolonged postoperative use of opioids when compared to other procedures. 2,10 Previous studies have shown that the minimally invasive surgical (MIS) approach is associated with less postoperative pain and analgesic needs than the open approach (OS) in patients with colon or rectal cancer.…”

Section: Introductionmentioning

confidence: 99%

Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study

Bastawrous

Shih

et al. 2020

The American Journal of Surgery

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a b s t r a c tBackground: Patients undergoing gastrointestinal surgery are at high risk for postoperative opioid use. Methods: We evaluated inpatient opioid use among patients undergoing sigmoidectomy for diverticular disease from the Premier Hospital Database and compared across surgical approaches using propensity score-matching analysis. Results: After the day of surgery, minimally invasive (MIS) patients were administered significantly lower doses of parenteral opioids (median daily morphine milligram equivalents [MME]: 33.3 versus 48.3, p < 0.001). Within MIS, significantly less parenteral opioids were used by the robotic-assisted (RS) than the laparoscopic (LS) group (median daily MME: 30.0 versus 36.8, p ¼ 0.012). MIS patients were more likely than open to start oral opioids on the day of surgery (MIS vs. OS: 8.7% vs. 6.6%, p < 0.001; RS vs. LS: 12.6% vs. 10.2%, p ¼ 0.048). Conclusion: Minimally invasive sigmoidectomy for diverticular disease was associated with less postoperative parenteral opioid use and starting oral opioids sooner after surgery compared to the open approach.

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“…Opioid analgesics are commonly used to manage moderate to severe acute pain among hospital inpatients . The National Institute for Health and Care Excellence identified opioids as a high‐risk medicine as they account for up to 16.1% of hospital adverse drug events (ADEs) . Opioid‐related ADEs include constipation, nausea, sedation and respiratory depression.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

Liu

Gnjidic

Nguyen

et al. 2020

Brit J Clinical Pharma

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Aims To summarise the effectiveness of interventions on appropriate opioid use for noncancer pain among hospital inpatients. Methods Two reviewers independently searched 6 databases up to March 2018 original research articles reporting on quantitative outcomes of interventions on appropriate opioid use among hospital inpatients. Appropriate opioid use was measured by changes in prescribing, such as the lowest effective opioid dose and duration, or clinical outcomes such as adequate pain control. Quality and intervention complexity assessments were performed by 2 independent reviewers. The full methodological approach was published on PROSPERO (ID: CRD42019145947). Results Of 398 full‐text articles assessed for eligibility, 37 articles were included in the review. Most articles had a moderate or high risk of bias (27 of 37 studies). Thirty‐one articles primarily addressed appropriate opioid use and 6 articles targeted opioid safety as a secondary outcome. A multifaceted approach was the most common primary intervention (16 studies) and adequate pain control was the main outcome measured (14 studies). Health provider education, reinforced by hard‐copy material and feedback, was associated with a 13.0 to 29.5% increase in the proportion of opioid prescriptions written in concordance with local guidelines and reduced pain scores ranging from 7.0 to 34.5%. Interventions to improve opioid safety in patient‐controlled analgesia reduced medication errors by up to 89.1%. Conclusion Interventions involving academic detailing and education, especially when reinforced by feedback, show positive effects on appropriate opioid use among hospital inpatients. Future studies investigating the impact of administrative interventions on opioid use and related outcomes are warranted.

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Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System

Cited by 174 publications

References 22 publications

Prescription opioid use is common and associated with worse clinical outcomes in individuals with chronic liver disease

Prescription opioid use is common and associated with worse clinical outcomes in individuals with chronic liver disease

Minimally invasive sigmoidectomy for diverticular disease decreases inpatient opioid use: Results of a propensity score-matched study

Effectiveness of interventions on the appropriate use of opioids for noncancer pain among hospital inpatients: A systematic review

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