Potential Opioid-Related Adverse Drug Events Are Associated With Decreased Revenue in Hip Replacement Surgery in the Older Population

Abstract

Introduction: Opioid-related adverse drug events (ORADEs) are an increasingly recognized complication associated with the common prescription of opioids after orthopedic surgery. In this study, we attempted to understand how potential ORADEs following hip replacement surgery in older patients affected hospital length of stay, hospital revenue, and their association with specific risk factors and clinically relevant diseases occurring during hospitalization. Methods: We conducted a retrospective study using the Centers for Medicare and Medicaid Services Administrative Database to analyze Medicare discharges after hip replacement surgery to identify potential ORADEs. The impact of potential ORADEs on mean hospital length of stay (LOS) and hospital revenue was analyzed. Results: The potential ORADE rate in patients who underwent hip replacement surgery was 8.6%. The mean LOS for discharges with a potential ORADE was 1.41 days longer than that for discharges without an ORADE. The mean hospital revenue per day with a potential ORADE was US$1708 less than without an ORADE. Potential ORADEs were also found to be strongly associated with poor patient outcomes such as pneumonia, septicemia, and shock. Discussion: Potential ORADEs in hip replacement surgery in older patients are associated with longer hospitalizations, decreased hospital revenue per day, certain patient risk factors, and clinically relevant diseases occurring during hospitalizations. Our finding of an association between potential ORADEs and decreased hospital revenue per day may be attributed to the management of these adverse events, as a patient may need to undergo additional testing, may need additional treatment regimens, and may need a higher level of care. Conclusion: By reducing the use of opioids and employing a multimodal analgesic approach, we may improve patient care, decrease hospital lengths of stay, and increase hospital revenue

Patient risk factors for opioid‐related adverse drug events in hospitalized patients: A systematic review

“…Older age and male gender were associated with a higher risk of experiencing all general ORADEs. Advanced age was a significant risk factor in all nine studies, 11‐13,20‐24,27 with most studies 11,12,20‐24 reporting that age of ≥65 years increased the odds of all general ORADEs by 1.1–2.3 times compared to those aged <65 years. Eight studies 11‐13,20‐24 identified male gender as a risk factor which would increase the odds of general ORADEs by 1.1–2.0 times compared to females.…”

“…These studies compared patients who experienced ORADEs and patients who did not (control group). Of these, 13 studies 11‐13,20‐29 involved a total of 1,887,711 surgical patients, one study 30 involved 731,208 medical patients, and two studies 31,32 involved a total of 355 hospitalized patients without stating the specialty (Table 1).…”

“…With respect to ORADEs investigated, seven studies 25,26,28‐32 focused on risk factors for over‐sedation and respiratory depression as they used administration of naloxone as their indicator for such ORADEs. Nine studies 11‐13,20‐24,27 focused on a combination of general ORADEs based on ICD codes (eg, respiratory, gastrointestinal, central nervous system, and genitourinary) (Table 2). These risk factors have been stratified to low‐moderate risk and high risk (Table 3).…”

“…Nine studies 11‐13,20‐24,27 focused on a combination of general ORADEs including respiratory, gastrointestinal, central nervous system, genitourinary, and pruritus. Of these, seven studies 11,12,20‐23,27 used ICD codes that are commonly associated with the ORADEs as stated above and two studies 13,24 also combined the use of naloxone administration as a surrogate.…”

“…Patients were more likely to experience general ORADEs if they had a higher overall comorbidity burden, which could be reflected by a higher Charlson Comorbidity Index (CCI) or Elixhauser Comorbidity Score 11,13,24 . Among all comorbid medical conditions, chronic obstructive pulmonary disease (COPD) was consistently revealed to be a risk factor for general ORADEs, which increased the risk by 1.2–2.3 times 12,20‐22,27 . Psychiatric disorders which included anxiety, depression, and mood orders were also commonly reported 13,20‐23,27 and increased the risk for general ORADEs by 16–21% 20‐23 .…”