Opioid Use Disorders and the Risk of Postoperative Pulmonary Complications

Sayal, Puneet; Bateman, Brian T.; Menendez, Mariano E.; Eikermann, Matthias; Ladha, Karim

doi:10.1213/ane.0000000000003307

Cited by 29 publications

(18 citation statements)

References 30 publications

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“…Recent studies have also found that patients with OUDs have an increased risk of developing pulmonary complications, including the need for extended mechanical intubation or reintubation. 31 In this study, OUD patients had 2.3-fold higher odds of developing pulmonary complications than non-OUD patients and faced higher odds of experiencing pneumonia and pulmonary embolism, but not acute respiratory failure. Taken together, our results are consistent with those previously reported in the literature, suggesting that OUD patients face higher odds of pulmonary complications postoperatively.…”

Section: Complicationsmentioning

confidence: 56%

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

Martini¹,

Nistal²,

Deutsch³

et al. 2019

Neurosurgical Focus

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OBJECTIVEThe authors set out to conduct the first national-level study assessing the risks and outcomes for different lumbar fusion procedures in patients with opioid use disorders (OUDs) to help guide the future development of targeted enhanced recovery after surgery (ERAS) protocols for this unique population.METHODSData for patients with or without OUDs who underwent an anterior lumbar interbody fusion (ALIF), posterior lumbar interbody fusion (PLIF), or lateral transverse lumbar interbody fusion (LLIF) for lumbar disc degeneration (LDD) were collected from the 2013–2014 National (Nationwide) Inpatient Sample database. Multivariable logistic regression was implemented to analyze how OUD status impacted in-hospital complications, length of hospital stay, discharge disposition, and total charges by procedure type.RESULTSA total of 139,995 patients with LDD were identified, with 1280 patients (0.91%) also having a concurrent OUD diagnosis. Overall complication rates were higher in OUD patients (48.44% vs 31.01%, p < 0.0001). OUD patients had higher odds of pulmonary (p = 0.0006), infectious (p < 0.0001), and hematological (p = 0.0009) complications. Multivariate regression modeling of outcomes by procedure type showed that after ALIF, OUD patients had higher odds of nonhome discharge (p = 0.0007), extended hospitalization (p = 0.0002), and greater total charges (p = 0.0054). This analysis also revealed that OUD patients faced higher odds of complication (p = 0.0149 and p = 0.0471), extended hospitalization (p = 0.0439 and p = 0.0001), and higher total charges (p < 0.0001 and p < 0.0001) after PLIF and LLIF procedures, respectively.CONCLUSIONSObtaining a better understanding of the risks and outcomes that OUD patients face perioperatively is a necessary step toward developing more effective ERAS protocols for this vulnerable population. This study, which sought to characterize the outcome profiles for lumbar fusion procedures in OUD patients on a national level, found that this population tended to experience increased odds of complications, extended hospitalization, nonhome discharge, and higher total costs. Results from this study warrant future prospective studies to better the understanding of these associations and to further the development of better ERAS programs that may improve patient care and reduce cost burden.

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Section: Complicationsmentioning

confidence: 56%

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

Martini¹,

Nistal²,

Deutsch³

et al. 2019

Neurosurgical Focus

View full text Add to dashboard Cite

show abstract

“…OPD has also been associated with factors prolonging length of stay, including postoperative nausea and vomiting, prolonged ileus, and urinary retention. These have also led to increased morbidity and mortality [10,24,25]. Our results demonstrate increased cost in effectively all aspects of hospitalization, including costs relating to operating room, supplies, intensive care, pharmacy, diagnostics, and ancillary treatments.…”

Section: Discussionmentioning

confidence: 70%

Preoperative opioid, sedative, and antidepressant use is associated with increased postoperative hospital costs in colorectal surgery

et al. 2020

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Background Opioid (OPD), sedative (SDT), and antidepressant (ADM) prescribing has increased dramatically over the last 20 years. This study evaluated preoperative OPD, SDT, and ADM use on hospital costs in patients undergoing colorectal resection at a single institution. Methods This study was a retrospective record review. The local ACS-NSQIP database was queried for adult patients (age ≥ 18 years) undergoing open/laparoscopic, partial/total colectomy, or proctectomy from January 1, 2013 to December 31, 2016. Individual patient medical records were reviewed to determine preoperative OPD, SDT, and AD use. Hospital cost data from index admission were captured by the hospital cost accounting system and matched to NSQIP query-identified cases. All ACS-NSQIP categorical patient characteristic, operative risk, and outcome variables were compared in medication groups using chi-square tests or Fisher's exact tests, and continuous variables were compared using Mann-Whitney U tests. Results A total of 1185 colorectal procedures were performed by 30 different surgeons. Of these, 27.6% patients took OPD, 18.5% SDT, and 27.8% ADM preoperatively. Patients taking OPD, SDT, and ADM were found to have increased mean total hospital costs (MTHC) compared to non-users (30.8 vs 23.6 for OPD, 31.6 vs 24.4 for SDT, and 30.7 vs 23.8 for ADM). OPD and SDT use were identified as independent risk factors for increased MTHC on multivariable analysis. Conclusion Preoperative OPD and SDT use can be used to predict increased MTHC in patients undergoing colorectal resections.

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“…Traditionally, opioid medications have been the cornerstone of postoperative pain management in surgery. However, as narcotic overuse has become more prevalent, a substantial increase in the rate of opioid dependency, drug-related deaths, and surge in health care resource utilization [15][16][17][18] has ensued. Consequently, new government regulations have emerged that place greater restrictions on the ability of physicians to prescribe narcotics with some laws even penalizing surgeons for excessive utilization.…”

Section: Discussionmentioning

confidence: 99%

Does Local Administration of Liposomal Bupivacaine Reduce Pain and Narcotic Consumption in Adult Spinal Deformity Surgery?

Chung

Crandall

Revella

et al. 2020

Global Spine Journal

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Study Design: Retrospective cohort study. Objective: To determine if local administration of liposomal bupivacaine (LB) reduces postoperative pain scores and narcotic use in spinal deformity patients. Methods: Adult patients undergoing elective spinal fusion (7 or more levels) for scoliosis or kyphosis were selected for inclusion. Patients received either periincisional injections of combined liposomal and standard bupivacaine (n = 90, group L) or standard bupivacaine only (n = 69, group C). Perioperative pain scores (VAS [visual analogue scale]), opioid use, length of stay, functional outcome (ODI [Oswestry Disability Index]), and perioperative complications were recorded. No external funding was received for this study. Results: A total of 159 patients met inclusion criteria (mean age was 54.2 years of age). No significant baseline demographic differences were noted between the 2 groups. Group L experienced slight improvements in pain control on postoperative day (POD) 1 ( P = .02). No difference in pain scores were otherwise noted. Group L transitioned off of intravenous (IV) narcotics faster with 52.6% less IV use by POD3 ( P = .03). No differences in total narcotic consumption, perioperative complications, lengths of stay, and functional outcome scores were otherwise noted between the 2 cohorts. Conclusions: The use of LB in adult spinal deformity surgery does not appear to provide clinically important improvements in postoperative pain at the manufacturer’s recommended dosage. Furthermore, while patients receiving LB may transition more quickly off of IV narcotics, this does not appear to translate into an overall decrease in narcotic consumption, hasten return of bowel function, or decrease hospital lengths of stay. Future prospective randomized control trials are warranted. The use of varying dosages of LB may also help further clarify the true efficacy of LB in the setting of spinal deformity surgery.

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Opioid Use Disorders and the Risk of Postoperative Pulmonary Complications

Cited by 29 publications

References 30 publications

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

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

Preoperative opioid, sedative, and antidepressant use is associated with increased postoperative hospital costs in colorectal surgery

Does Local Administration of Liposomal Bupivacaine Reduce Pain and Narcotic Consumption in Adult Spinal Deformity Surgery?

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