R. M. Shah1, S. A. Hirji1, S. McGurk1, M. P. Pelletier1, P. S. Shekar1, T. Kaneko1 1Brigham And Women’s Hospital,Division Of Cardiac Surgery,Boston, MA, USA
Introduction: Despite the ongoing epidemic, the clinical impact of opioid addiction on cardiac surgery outcomes is not well described. We evaluated the impact of opioid use on in-hospital outcomes among opioid-addicted patients after cardiac surgery.
Methods: Using the National Inpatient Sample, we isolated patients undergoing coronary artery bypass grafting, valve repair or valve replacement from 2009-2014. Patients were stratified by opioid use using ICD-9 codes. Multivariable analysis was performed to evaluate the association between opioid use and in-hospital outcomes.
Results: 1,743,161 patients underwent cardiac surgery, including 6,960 patients who suffered from opioid abuse or dependence (0.4%). Mean age was 47.2±14.9 and 65.8±12.8 years among opioid users and non-users, respectively. Although in-hospital mortality did not differ among opioid and non-opioid users (2.9% and 2.7%), opioid users had significantly longer hospital LOS (18 vs 10 days) and higher hospitalization costs ($81,238 vs $58,654; all p < 0.05). After adjusting for patient and hospital-level factors, opioid use was significantly associated with complete heart block (OR 1.9, 95% CI: 1.3-2.6), stroke (OR 1.71, 95% CI: 1.2-2.4), acute kidney injury (OR 1.3, 95% CI: 1.1-1.6), and longer hospital LOS (3.5 days, 95% CI: 2.4-4.6; all p<0.01) compared to non-opioid users. (Figure 1)
Conclusion: Cardiac surgery patients who suffer from opioid addiction are at high-risk for developing post-operative in-hospital complications. Strategies to minimize post-operative complications are warranted to improve overall morbidity and mortality in this vulnerable population in the context of the current opioid epidemic.
