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Impact of preexisting opioid dependence on morbidity, length of stay, and inpatient cost of urological oncological surgery

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Abstract

Objectives

To determine the incidence of preexisting opioid dependence in patients undergoing elective urological oncological surgery. In addition, to quantify the impact of preexisting opioid dependence on outcomes and cost of common urologic oncological procedures at a national level in the USA.

Methods

We used the National Inpatient Sample (NIS) to study 1,609,948 admissions for elective partial/radical nephrectomy, radical prostatectomy, and cystectomy procedures. Trends of preexisting opioid dependence were studied over 2003–2014. We use multivariable-adjusted analysis to compare opioid-dependent patients to those without opioid dependence (reference group) in terms of outcomes, namely major complications, length of stay (LOS), and total cost.

Results

The incidence of opioid dependence steadily increased from 0.6 per 1000 patients in 2003 to 2 per 1000 in 2014. Opioid-dependent patients had a significantly higher rate of major complications (18 vs 10%; p < 0.001) and longer LOS (4 days (IQR 2–7) vs 2 days (IQR 1–4); p < 0.001), when compared to the non-opioid-dependent counterparts. Opioid dependence also increased the overall cost by 48% (adjusted median cost $18,290 [IQR 12,549–27,715] vs. $12,383 [IQR 9225–17,494] in non-opioid-dependent, p < 0.001). Multivariable analysis confirmed the independent association of preexisting opioid dependence with major complications, length of stay in 4th quartile, and total cost in 4th quartile.

Conclusions

The incidence of preexisting opioid dependence before elective urological oncology is increasing and is associated with adverse outcomes after surgery. There is a need to further understand the challenges associated with opioid dependence before surgery and identify and optimize these patients to improve outcomes.

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Data availability

The National Inpatient sample data is publically available. We are not able to share the data, as it can be shared with those working on the project, and have signed a data use agreement with HCUP.

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Authors and Affiliations

  1. Vattikuti Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA

    Sohrab Arora, Chandler Bronkema, Sami E. Majdalany, Nicholas Corsi, Ivan Rakic, Austin Piontkowski, Akshay Sood, Matthew J. Davis, Daniele Modonutti & Firas Abdollah

  2. Vattikuti Urology Institute, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI, 48202-2689, USA

    Sohrab Arora, Craig G. Rogers & Firas Abdollah

  3. Wayne State University School of Medicine, Detroit, MI, USA

    Nicholas Corsi, Ivan Rakic, Austin Piontkowski & Firas Abdollah

  4. Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Akshay Sood

  5. Department of Oncological and Surgical Sciences, Urology Clinic, University of Padova, Padua, Italy

    Daniele Modonutti & Giacomo Novara

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  1. Sohrab Arora
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  2. Chandler Bronkema
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Correspondence to Firas Abdollah.

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Arora, S., Bronkema, C., Majdalany, S.E. et al. Impact of preexisting opioid dependence on morbidity, length of stay, and inpatient cost of urological oncological surgery. World J Urol 41, 1025–1031 (2023). https://doi.org/10.1007/s00345-023-04306-1

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  • DOI: https://doi.org/10.1007/s00345-023-04306-1

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