Adverse events associated with opioids administered for the management of surgery- and endoscopy-related pain may be associated with worse cost and patient outcomes, including higher inpatient mortality, higher rate of 30-day rehospitalization, and greater opioid use, according to a study published in JAMA Surgery.
In this retrospective study, investigators examined demographic and clinical data as well as information related to opioid intake (ie, type of opioid, opioid dose, and inpatient treatment duration) for 135,379 inpatients (≥18 years old; 67.5% women) who had undergone surgery or an endoscopic procedure between January 2013 and September 2015 and who had received ≥1 opioid.
Incidence of opioid-related adverse drug events was the primary outcome. Associations between opioid-related adverse events and patient outcomes (eg, mortality, discharge to another facility), as well as cost outcomes (eg, length of hospital stay, 30-day readmission), were evaluated.
A total of 14,386 patients (10.6%) reported ≥1 opioid-related adverse event. These events were more prevalent in patients who were white, older, men, and Medicare beneficiaries; in those who presented with comorbidities; and in those who had undergone endoscopic procedures, open thoracic procedures (37.6%), and open abdominal surgeries. The majority of patients who reported adverse events only experienced 1 event (73%), and 55.8% and 37.3% experienced at least 1 moderate or 1 severe event, respectively. The most common adverse events were respiratory, as well as nausea/vomiting and bradycardia.
Patients who experienced opioid-related adverse drug events had longer durations of opioid use (3.0 vs 2.0 days, respectively; P <.001) and higher doses of opioids administered during hospital stay (46.8 vs 30.0 morphine milligram equivalent, respectively; P <.001) compared with those who did not report adverse events. Opioids that were most associated with adverse events included morphine, fentanyl, and tramadol hydrochloride.
After adjusting for confounding variables (eg, age, race, sex), individuals reporting ≥1 vs no adverse event were at higher risk for mortality during hospital stay (odds ratio [OR], 28.8; 95% CI, 24.0-34.5), for being discharged to another care facility (OR, 2.9; 95% CI, 2.7-3.0), and for being readmitted within 30 days (OR, 1.3; 95% CI, 1.2-1.4). Patients with ≥1 vs no adverse event were also more likely to require longer hospital stays (OR, 3.1; 95% CI, 2.8-3.4) and to incur higher costs of hospitalization (OR, 2.7; 95% CI, 2.4-3.0). Adjusted risks for absolute mortality were 2.9% higher in individuals experiencing ≥1 vs no adverse event and were associated with higher hospitalization costs (additional $8225) and longer hospital stays (1.6 day longer).
Patients with severe vs mild opioid-related adverse drug events were at higher risk for dying (OR, 29.9; 95% CI, 7.4-120.6), for staying longer in the hospital (additional 9.9 and 1.8 days for severe/moderate vs mild adverse events, respectively), and for having higher adjusted hospitalization costs ($44,000 for severe/moderate events vs $7000 for mild events).
“Hospital-acquired harm from [opioid-related adverse drug events] in the surgical population is an important opportunity for health system patient safety interventions and cost variability reduction programs,” concluded the study authors.
Shafi S, Collinsworth AW, Copeland LA. Association of opioid-related adverse drug events with clinical and cost outcomes among surgical patients in a large integrated health care delivery system [published online May 23, 2018] JAMA Surg. doi: 10.1001/jamasurg.2018.1039