Potential disease burden of patients with substance abuse undergoing major abdominal surgery: A propensity score-matched analysis

Abstract

BackgroundOver 19 million Americans have a substance abuse disorder. The current study sought to characterize the relationship between substance abuse with in-hospital outcomes following major, elective abdominal surgery. MethodsThe Nationwide Inpatient Sample was used to identify patients who underwent major abdominal surgery between 2007 to 2014. Patients with preoperative substance abuse, including alcohol, opioids, and non-opioid drugs, were identified. Propensity score matching was used to examine the association of substance abuse with perioperative outcomes. ResultsAmong 301,659 patients, 7,925 patients (2.6%) had a history of substance abuse. Pancreatectomy was the surgical procedure with the highest proportion of patients with substance abuse history (n = 844, 4.7%). Compared with patients without a substance abuse history, patients with a substance abuse history were more likely to be younger (median age, 60 years [interquartile range (IQR) 52–69] vs 63 years [IQR 52–72]), male (n = 5,438, 67.5% vs n = 132,961, 54.7%), and be in the lowest income category (n = 2,062, 26% vs n = 64,345, 21.9%) (all P < .001). On propensity score matching, substance abuse was associated with increased odds ratio of experiencing a complication (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.55–1.82), non-home discharge (OR 1.95, 95% CI 1.76–2.16), extended length of stay (OR 1.88, 95% CI 1.76–2.02), and higher expenditure (OR 1.62, 95% CI 1.49–1.77). Stratified by the type of substance abuse, patients with history of alcohol (OR 1.57, 95% CI 1.44–1.71) and drug abuse (OR 1.26, 95% CI 1.14–1.39) were more likely to experience a complication, whereas only history of alcohol abuse was associated with higher odds ratio of in-hospital mortality (OR 1.38, 95% CI 1.07–1.79) (all P < .05). ConclusionUp to 1 in 50 patients undergoing complex abdominal surgery had a substance abuse history. History of substance abuse was associated with an increased risk of adverse perioperative outcomes and higher healthcare expenditures.