Variation in Inpatient Opioid Consumption Following Hepatopancreatic Surgery

Abstract

Introduction: The variation in inpatient opioid consumption among patients undergoing Hepatopancreatic surgery are unknown. We sought to examine the variability in inpatient opioid consumption following Hepatopancreatic surgery. Methods: All Hepatopancreatic cases performed at a single tertiary-care institution between 2015 and 2018 were identified. Only adults, who were prescribed an opioid during inpatient surgical admission and at time of discharge were included in the final cohort. High inpatient opioid consumption was defined as greater than the 75th percentile of average daily oral morphine equivalent (OME) intake. Results: Overall 891 patients were identified. The majority underwent a pancreatectomy (n=488, 54.8%) whereas a minority underwent a hepatectomy (n=403, 45.2%). Overall, median age was 63 (IQR: 55-71) and median comorbidity burden was 7 (IQR 5-8). Overall, the average daily morphine equivalent was 53 (IQR 25-105). Patients with high inpatient opioid consumption were more likely to be younger (57, IQR 50-66 vs 65, IQR 57-72, p< 0.05) whereas the comorbidity burden (6 IQR 5-8 vs 7 IQR 5-8) and sex (male: 54.2% vs 50.9%) was similar among patients with and without high opioid consumption (p>0.05). Individuals with high inpatient opioid consumption were 1.69 as likely to be readmitted (n=90, 40.0% vs n=157, 23.6%). On multivariable analysis, after adjusting for age, sex, length of operation, comorbidity burden and type of operation, individuals with high inpatient opioid consumption had more than twice the odds of readmission within 30-days (OR: 2.17, 95%CI 1.55-3.05). Discussion: High inpatient opioid consumption was associated with adverse post-discharge outcomes like readmission.