Impact of Preoperative Opioid Use After Emergency General Surgery
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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).
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.
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).
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.
KeywordsOpioids Narcotics Emergency general surgery Outcomes
body mass index
Clinical Data Base/Resource Manager
Centers for Disease Control
emergency general surgery
International Classification of Diseases, 9th version
lysis of adhesions
length of stay
morphine equivalent dose
Ohio Automated Rx Reported System
peptic ulcer disease
severity of illness
University of Cincinnati Medical Center
University HealthSystem Consortium
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.
Compliance with Ethical Standards
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.
- 1.Centers for Disease Control and Prevention. Vital Signs: Overdoses of Prescription Opioid Pain Relievers --- United States, 1999—2008. MMWR 2011; 60(43);1487–1492.Google Scholar
- 4.Centers for Disease Control and Prevention. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov.
- 5.America’s opioid epidemic is worsening. The Economist (U.K.). 2017 March 6.Google Scholar
- 10.Dowell D HT, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain [Internet]. 2016 [cited 17 June 2017]. Available from: https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm.
- 14.MED Calculator. Ohio Automated Rx Reporting System [Internet]. 2017 [cited 17 June 2017]. Available from: https://www.ohiopmp.gov/Portal/MED_Calculator.aspx
- 15.O’Donnell JA, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, et al. Preoperative Opioid Use is a Predictor of Poor Return to Work in Workers’ Compensation Patients after Lumbar Diskectomy. Spine (Phila Pa 1976) 2017.Google Scholar
- 17.Cheah JW, Sing DC, McLaughlin D, Feeley BT, Ma CB, Zhang AL. The perioperative effects of chronic preoperative opioid use on shoulder arthroplasty outcomes. J Shoulder Elbow Surg 2017.Google Scholar
- 22.Acute Prescribing Limits. Ohio Automated Rx Reporting System [Internet]. 2017 [cited 12 Sept 2017]. Available from: http://mha.ohio.gov/Portals/0/assets/Initiatives/GCOAT/AcutePrescribingLimits_FINAL.pdf.
- 23.Opioid Prescribing Guidelines. Ohio Automated Rx Reporting System [Internet]. 2017 [cited 12 Sept 2017]. Available from: http://mha.ohio.gov/Default.aspx?tabid=828.
- 24.Mettler K. ‘This is unprecedented’: 174 heroin overdoses in 6 days in Cincinnati. The Washington Post [Internet]. 2016 [cited 09 Sept 2017]. Available from: https://www.washingtonpost.com/news/morning-mix/wp/2016/08/29/this-is-unprecedented-174-heroin-overdoses-in-6-days-in-Cincinnati.