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Opioid Use Disorders and the Risk of Postoperative Pulmonary Complications

Sayal, Puneet, MD, MSc*; Bateman, Brian T., MD, MSc†,‡; Menendez, Mariano, MD§; Eikermann, Matthias, MD, PhD; Ladha, Karim S., MD, MSc

doi: 10.1213/ANE.0000000000003307
Chronic Pain Medicine: Original Laboratory Research Report

BACKGROUND: As the rate of opioid use disorders continues to rise, perioperative physicians are increasingly faced with the challenge of providing analgesia to these patients after surgery. Due to the likelihood of opioid dose escalation in the perioperative period, we hypothesized that opioid-dependent patients would be at increased risk for postoperative pulmonary complications.

METHODS: A retrospective cross-sectional analysis of patients undergoing 6 representative elective surgical procedures was performed using the Nationwide Inpatient Sample from 2002 to 2011. The primary outcome was a composite including prolonged mechanical ventilation, reintubation, and acute respiratory failure. Secondary outcomes were length of stay, in-hospital mortality, and total hospital costs. Both multivariable logistic regression and propensity score matching were used to determine the impact of opioid use disorder on outcomes.

RESULTS: The total sample-weighted cohort consisted of 7,533,050 patients. Patients with opioid use disorders were more likely to suffer pulmonary complications, with a frequency of 4.2% compared to 1.6% in the nonopioid-dependent group (P < .001), and had a 1.62 times higher odds (95% confidence interval [CI], 1.16–2.27) in multivariable regression analysis. In a secondary subgroup analysis, only patients undergoing a colectomy had a greater odds of suffering pulmonary complications (odds ratio, 2.64; 95% CI, 1.42–4.91; P = .0021). Additionally, patients with an opioid use disorder had a longer length of stay (0.84 days [95% CI, 0.52–1.16; P < .001]) and greater costs ($1816 [95% CI, 935–2698; P < .001]).

CONCLUSIONS: This study demonstrates that patients with opioid use disorders are at increased risk for postoperative pulmonary complications, and have prolonged length of stay and resource utilization. Further research is needed regarding interventions to reduce the risk of complications in this subset of patients.

From the *Division of Research, International Spine, Pain & Performance Center, Washington, DC

Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine

Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, Massachusetts

§Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts

Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Department of Anesthesia and Pain Medicine, Toronto General Hospital and University of Toronto, Toronto, Canada.

Published ahead of print March 21, 2018.

Accepted for publication December 19, 2017.

Funding: B. T. Bateman is supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (Bethesda, MD) under Award Numbers K08HD075831.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Reprints will not be available from the authors.

Address correspondence to Puneet Sayal, MD, MSc, Division of Research, International Spine, Pain & Performance Center, 2141 K St NW, Suite 600, Washington, DC 20037. Address e-mail to

© 2018 International Anesthesia Research Society
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