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Journal of Gastrointestinal Surgery

, Volume 22, Issue 6, pp 1098–1103 | Cite as

Impact of Preoperative Opioid Use After Emergency General Surgery

  • Young Kim
  • Alexander R. Cortez
  • Koffi Wima
  • Vikrom K. Dhar
  • Krishna P. Athota
  • Jason J. Schrager
  • Timothy A. Pritts
  • Michael J. Edwards
  • Shimul A. ShahEmail author
Original Article

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.

Keywords

Opioids Narcotics Emergency general surgery Outcomes 

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

Notes

Author 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.

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.

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Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  • Young Kim
    • 1
  • Alexander R. Cortez
    • 1
  • Koffi Wima
    • 1
  • Vikrom K. Dhar
    • 1
  • Krishna P. Athota
    • 1
  • Jason J. Schrager
    • 1
  • Timothy A. Pritts
    • 1
  • Michael J. Edwards
    • 1
  • Shimul A. Shah
    • 1
    • 2
    Email author
  1. 1.Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of SurgeryUniversity of CincinnatiCincinnatiUSA
  2. 2.Division of TransplantationUniversity of Cincinnati School of MedicineCincinnatiUSA

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