• Annals of surgery · Dec 2021

    Opioid Use Disorder is Associated With Complications and Increased Length of Stay After Major Abdominal Surgery.

    • Yun Song, Rebecca Tang, Robert E Roses, Douglas L Fraker, Ronald P DeMatteo, Rachel R Kelz, and Giorgos C Karakousis.
    • Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
    • Ann. Surg. 2021 Dec 1; 274 (6): 992-1000.

    ObjectiveThe objective of this study was to determine the impact of opioid use disorder (OUD) on perioperative outcomes after major upper abdominal surgeries.Summary Of Background DataOUD, defined as dependence/abuse, is a national health epidemic. Its impact on outcomes after major abdominal surgery has not been well characterized.MethodsPatients who underwent elective esophagectomy, total/partial gastrectomy, major hepatectomy, and pancreatectomy were identified using the National Inpatient Sample (2003-2015). Propensity score matching by baseline characteristics was performed for patients with and without OUD. Outcomes measured were in-hospital complications, mortality, length of stay (LOS), and discharge disposition.ResultsOf 376,467 patients, 1096 (0.3%) had OUD. Patients with OUD were younger (mean 53 vs 61 years, P < 0.001) and more often male (55.1% vs 53.2%, P < 0.001), black (15.0% vs 7.6%, P < 0.001), Medicaid beneficiaries (22.0% vs 6.4%, P < 0.001), and in the lowest income quartile (32.6% vs 21.3%, P < 0.001). They also had a higher rate of alcohol (17.2% vs 2.8%, P < 0.001) and nonopioid drug (2.2% vs 0.2%, P = 0.023) dependence/abuse. After matching (N = 1077 OUD, N = 2164 no OUD), OUD was associated with a higher complication rate (52.9% vs 37.3%, P < 0.001), including increased pain [odds ratio (OR) 3.5, P < 0.001], delirium (OR 3.0, P = 0.004), and pulmonary complications (OR 2.0, P = 0.006). Additionally, OUD was associated with increased LOS (mean 12.4 vs 10.6 days, P = 0.015) and nonroutine discharge (OR 1.6, P < 0.001). In-hospital mortality did not differ (OR 2.4, P = 0.10).ConclusionPatients with OUD more frequently experienced complications and increased LOS. Close postoperative monitoring may mitigate adverse outcomes.Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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