Clinical and Economic Implications Related to Postsurgical Analgesic Devices

Adamson, Robert T.; Lew, Indu; Beyzarov, Elena; Amara, Shilpa; Reitan, John

doi:10.1310/hpj4606-s12

Cited by 3 publications

(8 citation statements)

References 34 publications

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“…18 Ultimately, these negative downstream outcomes of ORADEs lead to diminished quality of life for the patient 20 and higher costs. 6,19 While opioid analgesics have been a mainstay of postsurgical analgesic regimens, recent treatment guidelines have supported the use of multimodal therapy as a way to decrease opioid usage, thus lowering the risk of ORADEs and their subsequent negative impact on clinical and economic outcomes while successfully managing postoperative pain. Current guidelines from the American Society of Anesthesiologists (ASA) and the American Pain Society (APS) advocate the use of multimodal postoperative pain management strategies.…”

Section: Study Design and Sample Selectionmentioning

confidence: 99%

“…Risk factors were selected based on previous research and biologic plausibility. 6,12,13,15 The incidence of ORADEs was similarly ascertained by identifying specific ICD-9-CM diagnosis codes and included GI, respiratory, and genitourinary (GU) diagnoses (Table 2). Patients were then placed into cohorts based on whether they experienced or did not experience any ORADE.…”

Section: Risk Factor Assessment and Identification Of Ades Risk Profimentioning

confidence: 99%

“…However, opioid use is frequently accompanied by opioid-related adverse drug events (ORADEs) and other negative consequences, including increased mortality. 6,7 Wheeler et al (2002) found that 29.0% of preventable adverse drug events (ADEs) were associated with analgesic use, the majority of which included opioids. 8 The most common of these ORADEs include gastrointestinal (GI) effects such as constipation, ileus, nausea, and vomiting; central nervous system effects including sedation, euphoria, and delirium; pruritus; urinary retention; and more serious adverse effects such as respiratory depression.…”

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confidence: 99%

“…11 Previously demonstrated patient-specific ADE risk factors include older age, male gender, race/ethnicity, smoking status, obesity, and comorbid diagnoses such as obstructive sleep apnea (OSA), chronic obstructive pulmonary disease (COPD), renal and hepatic function, cardiac dysrhythmia, degenerative joint disease (DJD), and benign prostatic hyperplasia (BPH). 6,[12][13][14][15] Medication error, which is common with opioid delivery systems, also contributes substantially to the risk of developing an ORADE. 16 • Opioid-related adverse drug events (ORADEs) are common causes of hospitalizations and increased health care costs.…”

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confidence: 99%

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Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

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BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility of a risk-scoring model in categorizing patients at high risk of experiencing ORADEs; and (c) quantify potential clinical/economic benefits of targeting high-risk GI surgical patients for opioid-sparing regimens in terms of hospitalization cost, length of stay (LOS), and 30-day readmission rates. METHODS: Using a retrospective design based on an administrative database, patients with an inpatient surgical procedure between January 1, 2010, and December 31, 2010, were included. GI surgical patients aged > 18 years followed from admission through 30 days postdischarge were characterized as high or low risk using clinical/demographic characteristics and were evaluated for several outcomes. Using multivariate logistic regression, the ORADE incidence, total hospitalization cost, LOS, and 30-day readmissions were compared for high-risk and low-risk patients. RESULTS: In 87.8% (n = 3,235) of the surgical population, there was a strong concordance between risk assignment and ORADE incidence. Among the remaining 12.2% (n = 449) of patients, 5.5% (n = 202) were low risk with an ORADE, and 6.7% (n = 247) were high risk without an ORADE. Overall, 20.6% (n = 344) of high-risk patients experienced ≥ 1 ORADE (mean cost: $31,988; LOS: 12.1 days) compared with only 5.3% (n = 107) of lowrisk patients (mean cost: $25,216; LOS: 8.0 days). High-risk patients had higher hospitalization costs and longer LOS than low-risk patients, respectively (mean cost: $19,234 vs. $13,036; mean LOS: 6.8 days vs. 3.3 days). These differences correspond to 47.0% higher costs for high-risk patients and an LOS approximately twice as long compared with low-risk patients. CONCLUSIONS: Patient clinical/demographic characteristics influence the risk of developing ORADEs. Risk assessment tools can effectively identify high-risk patients, thereby enabling interventions that can reduce ORADEs, decrease hospital costs, and improve postsurgical experiences for patients.

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Section: Study Design and Sample Selectionmentioning

confidence: 99%

Section: Risk Factor Assessment and Identification Of Ades Risk Profimentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

View full text Add to dashboard Cite

show abstract

“…More recently, researchers found that as many as 80% of patients who received opioid analgesics experienced ORADEs . In addition to opioid use, several demographic and clinical characteristics of patients have been linked to ADE risk such as age, sex, renal and hepatic function, comorbidities, presence of obstructive sleep apnea, and level of sedation …”

mentioning

confidence: 99%