Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures

Abstract

Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.

U.S. National 90-Day Readmissions After Opioid Overdose Discharge

“…This study supports previous research indicating that opioid use disorder is a risk factor for readmissions 7,11 and that many patients admitted for drug and alcohol overdose have serious comorbid health conditions. 19–21 High prevalence of comorbidities among opioid overdose inpatients highlights the need for a coordinated, careful, “warm handoff” transfer of patients to outpatient SUD treatment services, including effective communication between inpatient and outpatient clinicians.…”

Chronic opioid use after coronary bypass surgery

“…In our study, while in‐hospital outcomes were similar, opioid‐exposed patients had increased ICU time, longer hospital LOS, and higher 30‐day readmissions. These findings echo those previously reported in the literature that demonstrate that preoperative opioid abuse and dependence is associated with worse outcomes and higher healthcare utilization after surgery …”

Characterizing the risk and outcome profiles of lumbar fusion procedures in patients with opioid use disorders: a step toward improving enhanced recovery protocols for a unique patient population

“…10,25 This, in turn, can lead to prolonged hospitalizations, higher total costs, and increased readmission rates. 11 Accordingly, in the present study, patients with OUDs tended to perform more poorly in terms of resource utilization metrics, including extended hospitalization, nonhome discharge, and higher total costs of hospitalization. As such, the development of a more individualized ERAS model for this patient population may allow for novel cost-saving and resource utilization measures that have been previously unexplored.…”