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

Abstract

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.

Sufentanil Sublingual Tablet 30 mcg for the Management of Pain Following Abdominal Surgery: A Randomized, Placebo‐Controlled, Phase‐3 Study

“…A growing number of major surgical procedures are being performed in ASCs, and while effective employment of multimodal analgesia regimens can decrease the use of opioids, significant quantities of opioids are still utilized to provide adequate analgesia following these larger, more invasive surgeries . However, new advances in postoperative opioids have been lacking over the past 3 decades and current opioid analgesics (eg, intravenous [IV] morphine) have limitations …”

“…[8][9][10][11] However, new advances in postoperative opioids have been lacking over the past 3 decades and current opioid analgesics (eg, intravenous [IV] morphine) have limitations. [12][13][14][15][16][17][18] Disadvantages of IV morphine include a delayed plasma:central nervous system (CNS) equilibration halflife (t 1/2 k e0 ) of 2.8 hours, delayed effects of the active metabolite morphine-6-glucuronide (M6G), which has an even slower t 1/2 k e0 of 6.4 hours, and possibly a higher postoperative nausea and vomiting rate compared with fentanyl in ASCs. 19,20 Intravenous hydromorphone has a relatively shorter t 1/2 k e0 of 46 minutes, but results in a similar side effect profile as IV morphine, 21 with some studies suggesting a higher rate of postoperative sedation/CNS side effects with hydromorphone.…”

Strategies to Identify and Reduce Opioid Misuse Among Patients with Gastrointestinal Disorders: A Systematic Scoping Review

“…Outside of the use of PDMP data, Barth et al and Minkowitz et al described the use of screening tools administered to identify opioid misuse and opioid-related adverse events [65–66]. This strategy aligned with clinical information systems as the authors collected and incorporated patient- and population-level data to facilitate efforts to reduce opioid use.…”

“…Minkowitz et al reported on the development and validation of a risk score to identify patients at high risk for opioid-related adverse drug events [66]. In this large retrospective cohort analysis, GI surgical patients undergoing colectomy, cholecystectomy, gastrectomy and gastric bypass procedures (n = 3,684) were followed from admission through 30 days post-discharge.…”

“…Patients at higher risk for experiencing an opioid-related adverse event incurred higher hospitalization costs and longer lengths-of-stay compared to lower risk patients. The authors concluded that risk assessment tools can successfully identify high risk patients, and that these data can be used in interventions to reduce opioid-related adverse events [66]. …”