Impact of postsurgical opioid use and ileus on economic outcomes in gastrointestinal surgeries

Abstract

Objectives:To assess the incidence and economic impact of postoperative ileus (POI) following laparotomy (open) and laparoscopic procedures for colectomies and cholecystectomies in patients receiving postoperative pain management with opioids. Methods:Using the Premier research database, we retrospectively identified adult inpatients discharged between 2008 and 2010 receiving postsurgical opioids following laparotomy and laparoscopic colectomy and cholecystectomy. POI was identified through ICD-9 diagnosis codes and postsurgical morphine equivalent dose (MED) determined. Results:A total of 138,068 patients met criteria, and 10.3% had an ileus. Ileus occurred more frequently in colectomy than cholecystectomy and more often when performed by laparotomy. Ileus patients receiving opioids had an increased length of stay (LOS) ranging from 4.8 to 5.7 days, total cost from $9945 to $13,055 and 30 day all-cause readmission rate of 2.3 to 5.3% higher compared to patients without ileus. Patients with ileus received significantly greater MED than those without (median: 285 vs. 95 mg, p50.0001) and were twice as likely to have POI. MED above the median in ileus patients was associated with an increase in LOS (3.8 to 7.1 days), total cost ($8458 to $19,562), and readmission in laparoscopic surgeries (4.8 to 5.2%). Readmission rates were similar in ileus patients undergoing open procedures regardless of MED. Conclusions:Use of opioids in patients who develop ileus following abdominal surgeries is associated with prolonged hospitalization, greater costs, and increased readmissions. Furthermore, higher doses of opioids are associated with higher incidence of POI. Limitations are related to the retrospective design and the use of administrative data (including reliance on ICD-9 coding). Yet POI may not be coded and therefore underestimated in our study. Assessment of pre-existing disease and preoperative pain management was not assessed. Despite these limitations, strategies to reduce opioid consumption may improve healthcare outcomes and reduce the associated economic impact.

The safety and effectiveness of robot-assisted versus laparoscopic TME in patients with rectal cancer

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Perioperative impact of sleep apnea in a high-volume specialty practice with a strong focus on regional anesthesia: a database analysis

“…Opioid consumption has been associated with the development of postoperative ileus 34. In our dataset, patients with OSA had general anesthesia more often than patients with no OSA and therefore most likely received higher doses of opioids.…”

Postoperative opioid sparing with injectable hydroxypropyl-β-cyclodextrin-diclofenac: pooled analysis of data from two Phase III clinical trials

“…While opioids are efficacious analgesics, AEs associated with this drug class can be wide ranging and represent an important concern for clinicians and patients 2,4–9,45. Furthermore, opioid-related AEs in postsurgical patients are associated with increased hospital length of stay and added costs which recent studies have estimated to range from $4,707 to $13,737 per patient 9–11,46,47. Thus, multimodal pain management approaches that make use of analgesics with different mechanisms of action, such as the NSAIDs, are recommended 31,48…”