A. N. Cobb1,2, A. Kothari1,2, S. Brownlee2, P. Kuo1,2 1Loyola University Medical Center,Department Of Surgery,Maywood, IL, USA 2Loyola University Medical Center,One:MAP Division Of Clinical Informatics And Analytics,Maywood, IL, USA
Introduction: Increasing numbers of patients are using opioids for pain management. While there is growing recognition of the potentially negative implications of postoperative opioid use, little is known about the effect of opioid abuse in the preoperative setting. The objective of this study was to determine the prevalence of opioid abuse in patients undergoing low risk elective procedures and to assess its impact on postoperative morbidity, mortality, and resource utilization.
Methods: Patients with a preoperative diagnosis of opioid use disorder or dependence who underwent one of five low risk elective procedures (laparoscopic cholecystectomy, mastectomy, total knee replacement, gastric bypass, prostatectomy) were extracted using the Healthcare Cost and Utilization Project (HCUP) State Inpatient Database (SID) for California, New York, and Florida during the years 2009-2011. Descriptive statistics of the study population were calculated using arithmetic means with standard deviations for continuous variables and proportions for categorical variables. Risk-adjusted odds of mortality, morbidity, length of stay, and discharge disposition were calculated using mixed-effects regression models with fixed effects for age, race, sex, socioeconomic status, insurance type, and comorbid disease
Results: This study included 541,637 adult patients that underwent one of five elective surgical procedures. Of these, 403 patients (0.07%) were found to carry a preoperative diagnosis of opioid dependence. The largest proportion of patients with opioid dependence were Caucasian, female, privately insured, and of low socioeconomic status. The most common procedure in patients with opioid dependence was total knee replacement (322 patients). Patients with opioid use disorder were younger than those without (57 years vs 64 years p<0.001). Opioid use was not associated with inpatient mortality (OR=5.01, 95% C.I: 0.69 – 36.2), however it was associated with increased aggregate morbidity (OR=2.0, 95% C.I:1.19-3.39), the odds of having a non-routine discharge disposition (OR=0.38, 95% C.I: 0.30 – 0.48), and prolonged length of stay (OR=2.67, 95% C.I: .2.08 – 3.41).
Conclusion: Preoperative opioid use has a negative impact on postoperative outcomes and leads to increased resource utilization following low risk elective procedures. This presents an opportunity to create a preoperative screening tool to assess patients for opioid abuse or dependence. If patients are found to exhibit opioid abuse, a concerted effort should be made by surgeons to have these patients treated prior to elective surgical intervention, or decline to perform elective surgery on patients that misuse opioids and defer treatment.