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Opioid-related adverse events common after surgical, endoscopic procedures
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More than 10% of patients who underwent a surgical or endoscopic procedure experienced an opioid-related adverse drug event, and these were associated with worse outcomes and higher costs, according to new data published in JAMA Surgery.
These findings highlight reduced opioid prescribing as an important opportunity to improve patient safety and reduce costs in hospitals, investigators concluded.
Shahid Shafi, MD, MBA, MPH, of the Center for Clinical Effectiveness at Baylor Scott & White Health in Dallas, and colleagues conducted a retrospective study to determine the clinical and cost outcomes associated with opioid-related adverse drug events (ORADEs).
“Opioid addiction and deaths from opioid overdose have reached epidemic levels in the United States,” they wrote. “Policymakers, public health agencies and health care professionals are developing strategies to minimize the use of prescription opioids in the community. However, much less attention has been paid to the harm caused by short-term opioid us in hospitals.”
Shafi and colleagues analyzed clinical and administrative data from 135,379 patients who underwent a colorectal, general abdominal, obstetric/gynecological, orthopedic, spine, cardiac, cardiovascular, or endoscopic procedure and received opioids from January 2013 through September 2015. They pulled the data from 21 Baylor Scott & White Health acute care hospitals.
The primary outcome of the study was incidence of ORADEs, including respiratory, gastroenterological and central nervous system complications, which investigators identified using ICD-9 diagnosis codes or documented use of an opioid antagonist.
In their analysis, the investigators found that 14,386 patients (10.6%) experienced at least one ORADE. These patients received a higher dose of opioids (median morphine mg equivalent dose, 46.8 vs. 30 mg; P < .001) and for a longer duration (median, 3 vs. 2 days; P < .001).
Shafi and colleagues found that ORADEs were associated with increased inpatient mortality (OR = 28.8; 95% CI, 24–34.5), greater likelihood of discharge to another care facility (OR = 2.9; 95%CI, 2.7–3), prolonged length of stay (OR = 3.1; 95% CI, 2.8–3.4), high cost of hospitalization (OR = 2.7; 95% CI, 2.4–3), and higher rate of 30-day readmission (OR = 1.3; 95% CI, 1.2–1.4).
According to the study authors, ORADEs are not routinely used as hospital quality measures. However, they believe the data suggest that, perhaps, they should be.
“Our results indicate that it is important for hospitals to monitor and report ORADEs, including causes and associations, and to identify and implement strategies to reduce opioid use while improving outcomes and reducing costs,” they wrote. – by Alex Young
Disclosures: Shafi reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.
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