Cardiac Surgery in Patients With Opioid Use Disorder: An Analysis of 1.7 Million Surgeries

Rohan M. Shah, Sameer A. Hirji, Edward Percy, Samantha Landino, Farhang Yazdchi, Andrea Bellavia, Marc P. Pelletier, Prem S. Shekar, Tsuyoshi Kaneko

Research output: Contribution to journalArticlepeer-review

10 Scopus citations


Background: Adverse repercussions associated with the current opioid epidemic have been documented in many surgical specialties. This study evaluated the impact of opioid use disorder (OUD) on in-hospital cardiac surgery outcomes by using a large national database. Methods: Using the National Inpatient Sample, this study isolated patients undergoing coronary artery bypass grafting, valve repair, or valve replacement from 2009 to 2014. Patients were stratified by OUD status. Multivariable analysis was performed to evaluate the association between opioid use and postoperative outcomes. Patients were further stratified by surgery type. Results: Overall, 1,743,161 patients underwent cardiac surgery, and 6960 patients had OUD (0.4%). Mean age was 47.2 and 65.8 years among those with and without OUD, respectively. Although in-hospital mortality did not differ among these groups, patients with OUD had a significantly higher incidence of stroke (8.3% vs 2.8%) and acute kidney injury (21.4% vs 16.2%), longer hospital stays (18 days vs 10 days), and higher hospitalization costs ($81,238 vs $58,654; all P < .01). However, after adjusting for patient and hospital-level factors, OUD was associated only with a longer hospital length of stay (2.2 days; 95% confidence interval, 1.19 to 3.20) compared with non-opioid users. Conclusions: OUD among cardiac surgery patients is associated with prolonged hospitalization and increased risk of postoperative morbidity, mainly driven by the patient's preoperative risk factors. Strategies to minimize these risk factors at the prehospitalization level is warranted to curb the opioid epidemic and improve overall outcomes in this vulnerable population.

Original languageEnglish
Pages (from-to)1194-1201
Number of pages8
JournalAnnals of Thoracic Surgery
Issue number4
StatePublished - Apr 2020


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