Opioid-Related Adverse Drug Events in Surgical Hospitalizations: Impact on Costs and Length of Stay

Abstract

Opioid-related ADEs following surgery were associated with significantly increased LOS and hospitalization costs. These ADEs occurred more frequently in patients receiving higher doses of opioids.

Retrospective Analysis of Opioid Medication Incidents Requiring Administration of Naloxone

“…The second theme accounted for another 6 cases, which were determined to have occurred because of interactions between the opioid administered and patients' health condi- Morphine 5-10 mg IV q3h prn and P 6 ME order was used for several days, then 3 doses of codeine mg PO q4h prn 20 ME order were given within 8 h (n = 1) Two different opioids (both listed as prn orders on MAR) were Case 1: hydromorphone 1-2 mg IV/PO q3h prn P given at the same time (n = 3) and codeine mg PO q4h prn Case 2: codeine 30-60 mg PO q4h prn and morphine 5 mg PO q4h prn Case 3: morphine 2-5 mg IV q1h prn and morphine [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] mg PO q4h prn Previously scheduled opioid order was not stopped when new Hydromorphone SR 3 mg PO q12h and P regimen was initiated (n = 1) hydromorphone 2 mg SC q4h Previously scheduled opioid order was stopped by physician Hydromorphone SR 6 mg PO twice daily and E/T when new regimen was initiated but was still present on fentanyl 37 µg/h patch q72h MAR (n = 1) Theme 2: Interacting health conditions and drugs Morphine/meperidine metabolites accumulated in cases of Case 1: morphine 2.5-5 mg IV q4h prn P renal or liver dysfunction (n = 4)…”

“…6 Since then, multiple studies have identified opioids as common causes of harmful and costly ADEs. [7][8][9][10] ISMP and ISMP Canada also report medication incidents involving opioids, some of which have resulted in death. 11,12 Three opioids (morphine, hydromorphone, and fentanyl) remain on ISMP Canada's list of the top 5 drugs reported as causing harm through medication incidents, despite widespread education regarding the potential harms.…”

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

“…Maeda et al [33] recently reported that the prevalence of opioid abuse and dependence in women hospitalized for delivery across the United States increased by 127%, from 1.7 per 1000 delivery admissions in 1998 to 3.9 per 1000 delivery admissions in 2011. Although the observed frequency of opioid abuse and dependence among orthopaedic surgical inpatients could be considered small, the clinical and economic burdens to healthcare systems are substantial [30,36,40,44].…”

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

“…14,15,[17][18][19][20] The frequency of postoperative ORADEs also poses a significant economic burden and strain on resources to hospitals and health care providers. For example, respiratory depression and nausea/vomiting require increased monitoring by the nursing staff and increased utilization of supportive care therapies such as antiemetics.…”

“…18 Ultimately, these negative downstream outcomes of ORADEs lead to diminished quality of life for the patient 20 and higher costs. 6,19 While opioid analgesics have been a mainstay of postsurgical analgesic regimens, recent treatment guidelines have supported the use of multimodal therapy as a way to decrease opioid usage, thus lowering the risk of ORADEs and their subsequent negative impact on clinical and economic outcomes while successfully managing postoperative pain. Current guidelines from the American Society of Anesthesiologists (ASA) and the American Pain Society (APS) advocate the use of multimodal postoperative pain management strategies.…”