Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

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.

Enhanced recovery after thoracic surgery reduces discharge on highly dependent narcotics

“…Less addictive narcotics in these groups did not work and we would have to quickly transition to narcotic PCA and back to home regimen. Studies have shown that patients who are on narcotics prior to surgery were more likely to have a longer hospital stay, discharge to rehabilitation facility and higher readmission (15). We did not have enough patients to analyze determine if this is the case in our group but our overall experience is that it is more difficult to manage the post-operative pain in patients who were on narcotics pain medication prior to surgery.…”

Chronic Opioid Use After Surgery: Implications for Perioperative Management in the Face of the Opioid Epidemic

“…In a cohort of 200,005 patients undergoing elective surgery, 8.8% of patients were using opioids prior to surgery, 42 preoperative opioid use was associated with longer hospital stays, a higher rate of 30-day readmission, and increased healthcare expenditures at 90-,180-, and 365 days after surgery. 42 Similarly, long-term opioid use was associated with an increased risk of knee revision in the first year following total knee arthroplasty in a cohort of veterans.…”

“…In a cohort of 200,005 patients undergoing elective surgery, 8.8% of patients were using opioids prior to surgery, 42 preoperative opioid use was associated with longer hospital stays, a higher rate of 30-day readmission, and increased healthcare expenditures at 90-,180-, and 365 days after surgery. 42 Similarly, long-term opioid use was associated with an increased risk of knee revision in the first year following total knee arthroplasty in a cohort of veterans. 43 As patients taking opioids prior to surgery often require higher postoperative doses for extended periods of time, it is possible that these heightened postoperative opioid requirements increase vulnerability to a multitude of opioid-related adverse effects.…”

Effect of treatment modality on chronic opioid use in patients with T1/T2 oropharyngeal cancer

“…According to a national 2011 survey, an additional 5% of the US population over the age of 12 years reported nonmedical usage of opioid analgesics . Although opioids can deliver effective pain relief for acute pain, chronic usage is associated with numerous dose‐related adverse effects and increased consumption of health care resources . In a database review of more than 200 000 patients undergoing elective abdominal surgery, preoperative opioid use was independently associated with greater hospital costs, higher readmission rates, and longer hospital stays .…”

“…Although opioids can deliver effective pain relief for acute pain, chronic usage is associated with numerous dose‐related adverse effects and increased consumption of health care resources . In a database review of more than 200 000 patients undergoing elective abdominal surgery, preoperative opioid use was independently associated with greater hospital costs, higher readmission rates, and longer hospital stays . Furthermore, both the fatal and nonfatal overdose rate have markedly increased in the past decade and now exceeds that of heroin and cocaine combined .…”