Opioid Dependence and Prolonged Length of Stay in Lumbar Fusion

Tank, Allyson; Hobbs, Jonathan G.; Ramos, Edwin; Rubin, Daniel

doi:10.1097/brs.0000000000002714

Cited by 47 publications

(12 citation statements)

References 24 publications

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“…To our knowledge, this is the first national study to assess differences in hospital and PAC utilization between patients with and without OUD who are hospitalized for conditions requiring prolonged IV access. Our work is consistent with prior studies showing differential patterns of healthcare utilization and longer inpatient hospital stays for patients with OUD [ 2 , 3 , 5 , 18 , 19 ]. We build on these studies by exploring a variety of serious infections that disproportionately affect this population and demonstrating nationwide disparities in care even when accounting for several potential confounders.…”

Section: Discussionsupporting

confidence: 92%

Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: A nationwide observational study

Kim

Fine

et al. 2020

PLoS Med

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Background Patients with opioid use disorder (OUD) who are hospitalized for serious infections requiring prolonged intravenous antibiotics may face barriers to discharge, which could prolong hospital length of stay (LOS) and increase financial burden. We investigated differences in LOS, discharge disposition, and charges between hospitalizations for serious infections in patients with and without OUD. Methods and findings We utilized the 2016 National Inpatient Sample-a nationally representative database of all discharges from US acute care hospitals. The population of interest was all hospitalizations for infective endocarditis, epidural abscess, septic arthritis, or osteomyelitis. The exposure was OUD, and the primary outcome was LOS until discharge, assessed by using a competing risks analysis to estimate adjusted hazard ratios (aHRs). Adjusted odds ratio (aOR) of discharge disposition and adjusted differences in hospital charges were also reported. Of 95,470 estimated hospitalizations for serious infections (infective endocarditis, epidural abscess, septic arthritis, and osteomyelitis), the mean age was 49 years and 35% were

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Section: Discussionsupporting

confidence: 92%

Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: A nationwide observational study

Kim

Fine

et al. 2020

PLoS Med

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“…It is also possible that we need to devise more effective strategies weaning patients off opioids as inpatients rather than waiting until after discharge. The longer patients are receiving opioids, the greater is the risk for dependence with one study showing that opioid dependence was significantly associated with prolonged LOS in patients undergoing lumbar fusion [29].…”

Section: Discussionmentioning

confidence: 99%

A national database propensity score-matched comparison of minimally invasive and open colectomy for long-term opioid use

et al. 2021

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Background Opioid dependence is a public health crisis and surgery is a risk factor for long-term opioid use. Though minimally invasive surgery (MIS) is associated with less perioperative pain, demonstrating an association with less long-term opioid use would be another reason to justify adoption of minimally invasive techniques. We compared the rates for long-term opioid prescriptions among patients in a large national database who underwent minimally invasive and open colectomy. Methods Using the MarketScan Database, we retrospectively analyzed patients undergoing colon resection for benign and malignant diseases between 2013 and 2017. Among opioid-naïve patients who had ≥ 1 opioid prescriptions filled perioperatively (30 days before surgery to 14 days after discharge), propensity score matching was applied for group comparisons [open (OS) versus MIS, and laparoscopic (LS) versus robotic-assisted surgery (RS)]. The primary outcome was long-term opioid use defined as the proportion of patients with ≥ 1 long-term opioid prescriptions filled 90–180 days after discharge. Risks factors for long-term opioid use were assessed using logistic regression. Results Among the 5413 matched pairs in the MIS versus OS cohorts, MIS significantly reduced long-term opioid use of ‘any opioids’ (13.3% vs. 20.9%), schedule II/III opioids (11.7% vs. 19.2%), and high-dose opioids (4.3% vs. 7.7%; all p < 0.001). Among the 1195 matched pairs in the RS versus LS cohorts, RS was associated with less high-dose opioids (2.1% vs. 3.8%, p = 0.015) 90–180 days after discharge. Other risk factors for long-term opioid use included younger age, benign indications, tobacco use, mental health conditions, and > 6 Charlson comorbidities. Conclusion Minimally invasive colectomy is associated with a significant reduction in long-term opioid use when compared to OS. Robotic-assisted colectomy was associated with less high-dose opioids compared to LS. Increasing adoption of minimally invasive surgery for colectomy and including RS, where appropriate, may decrease long-term opioid use.

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“…Long-term opioid users have been reported to have poorer outcomes during surgical procedures due to being prone to injuries, and one proposed theory is that the adrenal suppression blunted the usual stress response during acute illness (57)(58)(59). In the surgical setting, chronic preoperative opioid use is associated with increased postoperative complications, including infection, poorer outcomes after surgery, longer hospital stays, and higher health care costs (60). Lastly, chronic opioid usage also leads to individuals reporting higher pain upon cessation of opioids.…”

Section: Individual Side Effectsmentioning

confidence: 99%

Full Opioid Agonists and Tramadol: Pharmacological and Clinical Considerations

Edinoff¹,

Kaplan²,

Khan³

et al. 2021

Anesth Pain Med

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: Opioids are mu receptor agonists and have been an important part of pain treatment for thousands of years. In order to use these drugs appropriately and successfully in patients, whether to control pain, to treat opiate-induced side effects, or opiate withdrawal syndromes, a solid understanding of the pharmacology of such drugs is crucial. The most recognized full agonist opioids are heroin, morphine, codeine, oxycodone, meperidine, and fentanyl. Phenanthrenes refer to a naturally occurring plant-based compound that includes three or more fused rings. The opioids derived from the opium plant are phenanthrene derivatives, whereas most synthetic opioids are simpler molecules that do not have multiple rings. Methadone acts as a synthetic opioid analgesic similar to morphine in both quality and quantity; however, methadone lasts longer and in oral form, has higher efficacy, and is considered a diphenylheptane. Fentanyl is a strong synthetic phenylpiperdine derivative that exhibits activity as a mu-selective opioid agonist approximately 50 to 100 times more potent than morphine. Meperidine is another medication which is a phenylpiperdine. Tramadol is considered a mixed-mechanism opioid drug, as it is a centrally acting analgesic that exerts its effects via binding mu receptors and blocking the reuptake of monoamines. Some of the most common adverse effects shared among all opioids are nausea, vomiting, pruritus, addiction, respiratory depression, constipation, sphincter of Oddi spasm, and miosis (except in the case of meperidine). Chronic opioid usage has also established a relationship to opioid-induced hypogonadism and adrenal suppression. Physicians must be stewards of opioid use and use opioids only when necessary.

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Opioid Dependence and Prolonged Length of Stay in Lumbar Fusion

Abstract: 3.

Cited by 47 publications

References 24 publications

Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: A nationwide observational study

Disparities in United States hospitalizations for serious infections in patients with and without opioid use disorder: A nationwide observational study

A national database propensity score-matched comparison of minimally invasive and open colectomy for long-term opioid use

Full Opioid Agonists and Tramadol: Pharmacological and Clinical Considerations

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