• Atul Gupta, Junaid Nizamuddin, Dalia Elmofty, Sarah L Nizamuddin, Avery Tung, Mohammed Minhaj, Ariel Mueller, Jeffrey Apfelbaum, and Sajid Shahul.
• From the Department of Anesthesia and Critical Care (A.G., J.N., D.E., S.L.N., A.T., M.M., J.A., S.S.) and the Department of Obstetrics and Gynecology/Section of Maternal Fetal Medicine (A.M.), University of Chicago, Chicago, Illinois; and the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (A.M.).
• Anesthesiology. 2018 May 1; 128 (5): 880-890.

BackgroundAlthough 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.MethodsA 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.ResultsAmong 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.ConclusionsOpioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.Visual AbstractAn online visual overview is available for this article at http://links.lww.com/ALN/B704.

35 keywords...

hide…