V. K. Dhar1, Y. Kim1, D. E. Go1, K. Wima1, A. D. Jung1, A. R. Cortez1, R. S. Hoehn1, S. A. Shah1 1University Of Cincinnati,Department Of Surgery,Cincinnati, OH, USA
Introduction: The overuse of prescription opioid medications is a growing epidemic in the United States. Recent studies have shown that preoperative narcotic use impacts hospital cost and outcomes in surgical patients, but the underlying reasons are unclear.
Methods: A single-center retrospective analysis was performed on surgical patients admitted with a diagnosis of intestinal obstruction between 2010 and 2014. Patients were grouped into active opioid and non-opioid user cohorts. Active opioid use was defined as having an opioid prescription interval overlapping the date of admission. Chronic opioid use was defined by duration of opioid use for 90 days or longer. Admission or intervention due to opioid-related illness was determined through consensus decision of two independent, blinded clinicians. Primary endpoint was to analyze the effect of active opioid use on hospital resource utilization.
Results: During the study period, 296 patients were admitted with a primary diagnosis of intestinal obstruction. Active opioid users accounted for 18.6% of patients, with a median length of opioid use of 164 days (IQR 54-344 days). Of these, 18.2% were on multiple narcotics at time of admission and 76.4% met criteria for chronic opioid use. Compared to non-opioid users, active users were found to have increased median length of stay (8 days vs 6 days, p<0.05) and higher hospital costs ($12,241 vs $8,489, p<0.05) during index admission. Subgroup analysis of active opioid users demonstrated that opioid-related conditions were responsible for ten admissions (18.2%) and two readmissions (3.6%). Among active users requiring surgical intervention, three patients (21.4%) underwent exploratory laparotomy with negative findings.
Conclusion: Active opioid users, comprising 19% of this cohort of emergency acute care surgery patients, are predisposed to avoidable admissions and interventions for opioid-related illnesses. Efforts to address opioid use in the surgical population may improve patient outcomes and overall healthcare spending.