Impact of Preoperative Opioid Use After Emergency General Surgery

• Published in: Journal of gastrointestinal surgery Vol. 22; no. 6; pp. 1098 - 1103
• Main Authors: Kim, Young, Cortez, Alexander R., Wima, Koffi, Dhar, Vikrom K., Athota, Krishna P., Schrager, Jason J., Pritts, Timothy A., Edwards, Michael J., Shah, Shimul A.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.06.2018; Springer Nature B.V
• Subjects: Adult; Analgesics, Opioid - therapeutic use; Direct Service Costs; Drug Prescriptions - statistics & numerical data; Emergencies; Female; Gastroenterology; Gastrointestinal surgery; Humans; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Narcotics; Original Article; Patient Readmission; Postoperative Period; Preoperative Period; Retrospective Studies; Surgery; Surgical Procedures, Operative; Emergency general surgery; Narcotics; Outcomes; Opioids
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-017-3665-x

Background Preoperative exposure to narcotics has recently been associated with poor outcomes after elective major surgery, but little is known as to how preoperative opioid use impacts outcomes after common, emergency general surgical procedures (EGS). Methods A high-volume, single-center analysis was performed on patients who underwent EGS from 2012 to 2013. EGS was defined as the seven emergent operations that account for 80% of the national burden. Preoperative opioid use was defined as having an active opioid prescription within 7 days prior to surgery. Chronic opioid use was defined as having an opioid prescription concurrent with 90 days after discharge. Results A total of 377 patients underwent EGS during the study period. Preoperative opioid use was present in 84 patients (22.3%). Preoperative opioid users had longer hospital LOS (10.5 vs 6 days), higher costs of care ($25,331 vs $11,454), and higher 30-day readmission rates (22.6 vs 8.2%) compared with opioid-naïve patients ( p  < 0.001 each). After covariate adjustment, preoperative opioid use was predictive of LOS (RR 1.19 [1.01–1.41]) and 30-day hospital readmission (OR 2.69 [1.25–5.75]) ( p  < 0.05 each). Total direct cost was not different after modeling. Preoperative opioid users required more narcotic refills compared with opioid-naïve patients (5 vs 0 refills, p  < 0.001). After discharge, 15.4% of opioid-naïve patients met criteria for chronic opioid use, vs 77.4% in preoperative opioid users ( p  < 0.001). Conclusions Preoperative opioid use is associated with greater resource utilization after emergency general surgery, as well as vastly different postoperative opioid prescription patterns. These findings may help to inform the impact of preoperative opioid use on patient care, and its implications on hospital and societal cost.