Economic Burden and Clinical Impact of Opioid Dependence in Patients Undergoing Lower Extremity Bypass Surgery: Quantifying the Cost of a New Epidemic

Abstract

Surgeons’ contributions to the opioid epidemic have received significant attention in the media. Few data exist, however, of the impact of prior or coexistent opioid use on vascular surgery outcomes. This study aimed to quantify the economic impact of pre-existing opioid dependency in patients undergoing lower extremity bypass surgery. Data were collected from 1,132,317 patient admissions for lower extremity bypass in the National Inpatient Sample from years 2002 to 2015. Patients with a concomitant diagnosis of opioid abuse or dependency were identified by International Classification of Diseases, Ninth Revision codes. Matched cohorts of patients with and without opioid dependence were created using coarsened exact matching to control for patients’ demographics. Linear regression was used to control for hospital-level factors and to identify differential outcomes for patients with opioid dependency. There were 3189 (0.3%) patients undergoing lower extremity bypass who were found to have a concomitant opioid use disorder. The incidence of opioid dependency rose over time (0.13% [2002]; 0.63% [2015]; P < .001; Fig). Before matching, opioid-dependent patients were younger (53.9 ± 12.3 years vs 66.7 ± 12.1 years; P < .001) and more likely to be male (65.2% vs 61.9%; P < .001), to be nonwhite (37.9% vs 24.1%; P < .001), to pay with Medicaid (29.6% vs 7.4%; P < .001), and to fall in the lowest income quartile based on ZIP code (39.6% vs 27.5%; P < .001). After matching, there was no difference in in-hospital mortality (1.7% vs 2.1%; P = .5), myocardial infarction (2.1% vs 2.4%; P = .7), pulmonary embolism (0.8% vs 0.4%; P = .08), or amputation (2.4% vs 1.8%; P = .16). Opioid-dependent patients were more likely to have surgical site infections (12.0% vs 5.9%; P < .001), septicemia (5.0% vs 3.3%; P = .03), and acute renal failure (13.0% vs 8.2%; P < .001). Linear regression of matched cohorts revealed that opioid-dependent patients had an increased length of stay (12.5 days vs 9.1 days; P < .001) and increased mean inflation-adjusted cost of $10,608 ($40,127 vs $29,519; P < .001). Patients with opioid use disorder undergoing lower extremity bypass surgery have staggering increases in length of hospital stay and costs. Furthermore, the rise in the incidence of opioid dependency highlights the importance of early preoperative recognition of this disorder in patients undergoing vascular surgery and opens the opportunity for early intervention.