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Impact of Preoperative Opioid Use After Emergency General Surgery

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

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.

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Abbreviations

BMI:

body mass index

CDB/RM:

Clinical Data Base/Resource Manager

CDC:

Centers for Disease Control

EGS:

emergency general surgery

ICD-9:

International Classification of Diseases, 9th version

IQR:

interquartile range

LOA:

lysis of adhesions

LOS:

length of stay

MED:

morphine equivalent dose

OARRS:

Ohio Automated Rx Reported System

OR:

odds ratio

PUD:

peptic ulcer disease

RR:

relative risk

SOI:

severity of illness

UCMC:

University of Cincinnati Medical Center

UHC:

University HealthSystem Consortium

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Author information

Authors and Affiliations

  1. Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati, Cincinnati, OH, USA

    Young Kim, Alexander R. Cortez, Koffi Wima, Vikrom K. Dhar, Krishna P. Athota, Jason J. Schrager, Timothy A. Pritts, Michael J. Edwards & Shimul A. Shah

  2. Division of Transplantation, University of Cincinnati School of Medicine, 231 Albert Sabin Way, ML 0558, MSB 2006C, Cincinnati, OH, 45267-0558, USA

    Shimul A. Shah

Authors
  1. Young Kim
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  2. Alexander R. Cortez
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  3. Koffi Wima
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  4. Vikrom K. Dhar
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  5. Krishna P. Athota
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  6. Jason J. Schrager
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  7. Timothy A. Pritts
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  8. Michael J. Edwards
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  9. Shimul A. Shah
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Contributions

All authors made substantial contributions to the conception or design of the work or acquisition, analysis, and interpretation of the data. All authors were involved with either drafting or critical revision of the manuscript. All authors approve of the final version to be published. All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Shimul A. Shah.

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Conflicts of Interest

The authors declare that they have no conflicts of interest.

Grants and Financial Support

This study was funded by the University of Cincinnati Department of Surgery.

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Kim, Y., Cortez, A.R., Wima, K. et al. Impact of Preoperative Opioid Use After Emergency General Surgery. J Gastrointest Surg 22, 1098–1103 (2018). https://doi.org/10.1007/s11605-017-3665-x

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  • DOI: https://doi.org/10.1007/s11605-017-3665-x

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