In‐hospital use of opioids increases rate of coded postoperative paralytic ileus

Goettsch, Wim; Sukel, M; Peet, Donald L. van der; Riemsdijk, Melanie M. van; Herings, Ron M. C.

doi:10.1002/pds.1338

Cited by 56 publications

(34 citation statements)

References 17 publications

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“…Conversion of dispensed opioids to MED permits the quantification of morphine in all compounds. Morphine, unlike other opiates, has a more pronounced impact on POI 30 . It is a natural opium alkaloid with greater affinity and selectivity for mu-opioid receptors, and its metabolites are more potent than morphine itself.…”

Section: Discussionmentioning

confidence: 94%

“…Intravenously administered morphine has a more pronounced effect on the mu-opioid receptors in the gut than epidural administration 30 . Barletta et al in their study of 279 patients undergoing open and laparoscopic colectomies found a correlation of intravenous opioid use with total hydromorphone dose, maximum daily hydromorphone dose, average daily hydromorphone dose and days of intravenous narcotics.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, although we did not address the effect of opioid route of administration on POI, all have an influence 10,15,30 . Intravenously administered morphine has a more pronounced effect on the mu-opioid receptors in the gut than epidural administration 30 .…”

Section: Discussionmentioning

confidence: 99%

“…Specific to our study is reliance on accurate and complete ICD-9 coding. In the case of POI, since it is an expected complication of intra-abdominal surgery, physicians do not always code for it or its symptoms unless it exceeds 3 days 7,30 . Hence, the incidence observed in this study could be underestimated.…”

Section: Discussionmentioning

confidence: 99%

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

Gan

Robinson²,

Oderda

et al. 2015

Current Medical Research and Opinion

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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.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Gan

Robinson²,

Oderda

et al. 2015

Current Medical Research and Opinion

View full text Add to dashboard Cite

show abstract

“…15,29,30 In the setting of postsurgical analgesia, opioids are frequently administered via patientcontrolled analgesia (PCA) devices that permit selfadministration of small opioid doses which allow patients to have some control of the prescribed analgesic regimen. 1,31 Although the use of PCA improves pain control and patient satisfaction, 32 the incidence of ADEs associated with opioid PCA appears similar to that associated with other methods of administration.…”

Section: The Challenge Of Ades and The Rationale For Multimodal Analgmentioning

confidence: 99%

Evolving Role of Local Anesthetics in Managing Postsurgical Analgesia

Golembiewski

Dasta

2015

Clinical Therapeutics

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Pharmacy‐Based Medical Record Linkage Systems

Herings¹,

Pedersen²

2012

Pharmacoepidemiology

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In‐hospital use of opioids increases rate of coded postoperative paralytic ileus

Abstract: This study demonstrated a distinct association between the use of opioids, in particular natural opium alkaloids, and the risk for coded POI.

Cited by 56 publications

References 17 publications

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

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

Evolving Role of Local Anesthetics in Managing Postsurgical Analgesia

Pharmacy‐Based Medical Record Linkage Systems

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