The Impact of Opioid Use on Human and Healthcare Costs in Surgical Patients

Abstract

Background: Preoperative narcotic use impacts hospital cost and outcomes in surgical patients, but the underlying reasons are unclear. Methods: A single-center retrospective analysis was performed on surgical patients admitted with intestinal obstruction (2010-2014). Patients were grouped into active opioid and non-opioid user cohorts. Active opioid use was defined as having an opioid prescription overlapping the date of admission. Chronic opioid use was defined by duration of use ≥90 days. Admission or intervention due to opioid-related illness was determined through consensus decision of two independent, blinded clinicians. Primary endpoint was the effect of active opioid use on hospital resource utilization. Results: During the study period, 296 patients were admitted with a primary diagnosis of intestinal obstruction. Active opioid users accounted for 55 (18.6%) of these patients, with a median length of opioid use of 164 days (IQR 54-344 days). Average length of use was 164 days, with the majority of active users (n=42, 76.4%) meeting criteria for chronic use. A subgroup analysis of active users demonstrated that opioid-related conditions were responsible for ten admissions (18.2%) and two readmissions (3.6%). Among active users requiring surgical intervention, three procedures (21.4%)were due to opioid-related illnesses. Median hospital length of stay was two days longer (8 vs 6days) and hospital costs were greater ($12,241 vs $8,489) among active users (p<0.05 each). Conclusion: Active opioid users are predisposed to avoidable admissions and interventions for opioid-related illnesses. Efforts to address opioid use in the surgical population may improve patient outcomes and healthcare spending.