Kathleen C Clement1, Joseph K Canner2, Marc S Sussman3, Caitlin W Hicks4, Harleen K Sandhu5, Anthony L Estrera5, Joseph S Coselli6, Subhasis Chatterjee6. 1. Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: kathleen.clement@utsouthwestern.edu. 2. Johns Hopkins Surgery Center for Outcomes Research, Johns Hopkins University School of Medicine, Baltimore, Maryland. 3. Division of Cardiac Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 4. Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland. 5. Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas. 6. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Abstract
BACKGROUND: The incidence and financial impact of persistent opioid use (POU) after open aortic surgery is undefined. METHODS: Insurance claim data from opioid-naïve patients who underwent aortic root replacement, ascending aortic replacement or transverse arch replacement from 2011 to 2017 were evaluated. Persistent opioid use was defined as filling an opioid prescription in the perioperative period and between 90 and 180 days after surgery. Postoperative opioid prescriptions, emergency room visits, readmissions and healthcare costs were quantified. Multivariable logistic regression identified risk factors for POU, and quantile regression quantified the impact of POU on postoperative healthcare costs. RESULTS: Among 3,240 opioid-naïve patients undergoing open aortic surgery, 169 (5.2%) of patients had POU. In the univariate analysis, patients with POU were prescribed more perioperative opioids (375 vs. 225 morphine milligram equivalents, p<0.001), had more emergency room visits (45.6% vs. 25.4%, p<0.001) and had significantly higher healthcare payments in the 6 months after surgery ($10,947 vs. $7,223, p<0.001). Independent risk factors for POU in the multivariable logistic regression included preoperative nicotine use and more opioids in the first perioperative prescription (all p<0.05). After risk adjustment, POU was associated with a $2,439 increase in total healthcare costs in the 6 months after surgery. CONCLUSIONS: POU is a challenge after open aortic surgery and can have longer term impacts on healthcare payments and emergency room visits in the 6 months after surgery. Strategies to reduce outpatient opioid use after aortic surgery should be encouraged when feasible.
BACKGROUND: The incidence and financial impact of persistent opioid use (POU) after open aortic surgery is undefined. METHODS: Insurance claim data from opioid-naïve patients who underwent aortic root replacement, ascending aortic replacement or transverse arch replacement from 2011 to 2017 were evaluated. Persistent opioid use was defined as filling an opioid prescription in the perioperative period and between 90 and 180 days after surgery. Postoperative opioid prescriptions, emergency room visits, readmissions and healthcare costs were quantified. Multivariable logistic regression identified risk factors for POU, and quantile regression quantified the impact of POU on postoperative healthcare costs. RESULTS: Among 3,240 opioid-naïve patients undergoing open aortic surgery, 169 (5.2%) of patients had POU. In the univariate analysis, patients with POU were prescribed more perioperative opioids (375 vs. 225 morphine milligram equivalents, p<0.001), had more emergency room visits (45.6% vs. 25.4%, p<0.001) and had significantly higher healthcare payments in the 6 months after surgery ($10,947 vs. $7,223, p<0.001). Independent risk factors for POU in the multivariable logistic regression included preoperative nicotine use and more opioids in the first perioperative prescription (all p<0.05). After risk adjustment, POU was associated with a $2,439 increase in total healthcare costs in the 6 months after surgery. CONCLUSIONS: POU is a challenge after open aortic surgery and can have longer term impacts on healthcare payments and emergency room visits in the 6 months after surgery. Strategies to reduce outpatient opioid use after aortic surgery should be encouraged when feasible.