TY - JOUR
T1 - Assessment of Preoperative Opioid Use Prevalence and Clinical Outcomes in Pulmonary Resection
AU - Subramanian, Melanie P.
AU - Sahrmann, John M.
AU - Nickel, Katelin B.
AU - Olsen, Margaret A.
AU - Bottros, Michael
AU - Heiden, Brendan
AU - Semenkovich, Tara R.
AU - Meyers, Bryan F.
AU - Kozower, Benjamin D.
AU - Patterson, G. Alexander
AU - Nava, Ruben G.
AU - Kreisel, Daniel
AU - Puri, Varun
N1 - Funding Information:
The authors wish to acknowledge that Dr Subramanian received a Just-in-Time grant from the Washington University Institute of Clinical and Translational Sciences . Dr Puri is the principal investigator of National Institutes of Health (NIH) grants I01 HX002475-01A2 and R01 HL146856-01A1 . This work was supported by grant UL1 TR002345 from the National Center for Advancing Translational Sciences of the NIH and grant number R24 HS19455 through the Agency for Healthcare Research and Quality .
Funding Information:
The authors wish to acknowledge that Dr Subramanian received a Just-in-Time grant from the Washington University Institute of Clinical and Translational Sciences. Dr Puri is the principal investigator of National Institutes of Health (NIH) grants I01 HX002475-01A2 and R01 HL146856-01A1. This work was supported by grant UL1 TR002345 from the National Center for Advancing Translational Sciences of the NIH and grant number R24 HS19455 through the Agency for Healthcare Research and Quality.
Publisher Copyright:
© 2021 The Society of Thoracic Surgeons
PY - 2021/6
Y1 - 2021/6
N2 - Background: Preoperative opioid use is associated with increased health care use after elective abdominal surgery. However, the scope of preoperative opioid use and its association with outcomes have not been described in elective pulmonary resection. This study aimed to characterize prevalent preoperative opioid use in patients undergoing elective pulmonary resection and compare clinical outcomes between patients with and without preoperative opioid exposure. Methods: The study investigators assembled a retrospective cohort of adult patients undergoing elective pulmonary resection by using the IBM Watson Health MarketScan Database (2007 to 2015). The study compared opioid-naïve patients with patients with a history of preoperative opioid exposure (>0 morphine milligram equivalent prescription filled within 90 days before surgery). Multivariable logistic and linear regressions adjusting for patient sociodemographic, comorbidity, and operative characteristics were used to compare odds of postoperative complication, prolonged length-of-stay (>14 days), 30-day postdischarge emergency department visits, 90-day readmissions, and 90-day costs. Results: The study identified 14,373 patients, 4502 (31.3%) of whom had opioid exposure before pulmonary resection. In multivariable regression, patients with preoperative opioid exposure had significantly higher odds of experiencing a prolonged length of stay (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11 to 1.58), 30-day emergency department visits (OR, 1.24; 95% CI, 1.01 to 1.41), and 90-day readmissions (OR, 1.41; 95% CI, 1.28 to 1.55). Adjusted 90-day costs were approximately 5% higher for patients with preoperative opioid use (P <.001). Conclusions: One-third of patients who underwent pulmonary resection used opioids preoperatively and were at risk of experiencing adverse outcomes and having significantly higher health care use. They represent a unique high-risk population that will require novel, targeted interventions.
AB - Background: Preoperative opioid use is associated with increased health care use after elective abdominal surgery. However, the scope of preoperative opioid use and its association with outcomes have not been described in elective pulmonary resection. This study aimed to characterize prevalent preoperative opioid use in patients undergoing elective pulmonary resection and compare clinical outcomes between patients with and without preoperative opioid exposure. Methods: The study investigators assembled a retrospective cohort of adult patients undergoing elective pulmonary resection by using the IBM Watson Health MarketScan Database (2007 to 2015). The study compared opioid-naïve patients with patients with a history of preoperative opioid exposure (>0 morphine milligram equivalent prescription filled within 90 days before surgery). Multivariable logistic and linear regressions adjusting for patient sociodemographic, comorbidity, and operative characteristics were used to compare odds of postoperative complication, prolonged length-of-stay (>14 days), 30-day postdischarge emergency department visits, 90-day readmissions, and 90-day costs. Results: The study identified 14,373 patients, 4502 (31.3%) of whom had opioid exposure before pulmonary resection. In multivariable regression, patients with preoperative opioid exposure had significantly higher odds of experiencing a prolonged length of stay (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.11 to 1.58), 30-day emergency department visits (OR, 1.24; 95% CI, 1.01 to 1.41), and 90-day readmissions (OR, 1.41; 95% CI, 1.28 to 1.55). Adjusted 90-day costs were approximately 5% higher for patients with preoperative opioid use (P <.001). Conclusions: One-third of patients who underwent pulmonary resection used opioids preoperatively and were at risk of experiencing adverse outcomes and having significantly higher health care use. They represent a unique high-risk population that will require novel, targeted interventions.
UR - http://www.scopus.com/inward/record.url?scp=85103104602&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2020.07.043
DO - 10.1016/j.athoracsur.2020.07.043
M3 - Article
C2 - 33011165
AN - SCOPUS:85103104602
SN - 0003-4975
VL - 111
SP - 1849
EP - 1857
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -