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Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery

Waljee, Jennifer F. MD, MPH, MS; Cron, David C. BS; Steiger, Rena M. MPH; Zhong, Lin MD, MPH; Englesbe, Michael J. MD; Brummett, Chad M. MD

doi: 10.1097/SLA.0000000000002117
Special Series

Objective: To examine the extent to which preoperative opioid use is correlated with healthcare utilization and costs following elective surgical procedures.

Summary Background Data: Morbidity and mortality associated with prescription opioid use is escalating in the United States. The extent to which chronic opioid use influences postoperative outcomes following elective surgery is not well understood.

Methods: Truven Health Marketscan Databases were used to identify adult patients who underwent elective abdominal surgery between June 2009 and December 2012 (n = 200,005). Generalized linear regression was used to determine the effect of preoperative opioid use on postoperative healthcare utilization (length of stay, 30-d readmission, and discharge destination) and cost (hospital stay, 90-, 180-, and 365-d) after adjusting for number of comorbidities, psychological conditions, and demographic characteristics.

Results: In this cohort, 8.8% of patients used opioids preoperatively. Compared with non-users, patients using opioids preoperatively were more likely to have a longer hospital stay (2.9 d vs. 2.5 d, P <0.001) and were more likely to be discharged to a rehabilitation facility (3.6% vs. 2.5%, P <0.001), adjusting for covariates. Preoperative opioid use was also correlated with a greater rate of 30-day readmission (4.5% vs. 3.6%, P <0.001) and overall greater expenditures at 90- ($12036.60 vs. $3863.40, P <0.001), 180- ($16973.70 vs. $6790.60, P <0.001), and 365- ($25495.70 vs. $12113.80, P <0.001) days following surgery, adjusted for covariates. Additionally, dose-effects were observed regarding readmission, discharge destination, and late healthcare expenditures.

Conclusions: Preoperative interventions focused on opioid cessation and alternative analgesics may improve the safety and efficiency of elective surgery among chronic opioid users.

*Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI

University of Michigan Medical School, Ann Arbor, MI

Section of Transplant Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI

§Department of Anesthesia, University of Michigan Health System, Ann Arbor, MI.

Reprints: Jennifer F. Waljee, MD, MPH, MS, University of Michigan Health System, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109. E-mail: filip@med.umich.edu.

This research was supported by a Mentored Clinical Investigator Award to Dr JFW through the Agency for Healthcare Research and Quality (1K08HS023313-01). The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Dr JFW receives research funding from the Agency for Healthcare Research and Quality (K08 1K08HS023313-01), the American College of Surgeons, and the American Foundation for Surgery of the Hand; serves as an unpaid consultant for 3 M Health Information systems. Dr CMB receives research funding from the National Institutes of Health, NIAMS R01 AR060392 and NIDA 1R01DA038261-01A1, as well as the University of Michigan Medical School Dean's Office (Michigan Genomics Initiative). Dr CMB also serves as a consultant for Tonix Pharmaceuticals (New York, NY), and receives research funding from Neuros Medical Inc. (Willoughby Hills, OH). No other authors have any relationships to disclose.

The authors report no conflicts of interest.

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