Among patients undergoing cardiac surgery, those with vs without opioid use disorder (OUD) may have higher rates of complications and encounter greater costs, according to a report published in JAMA Surgery.
In this retrospective population-based cohort study, data from >5.7 million US adults who underwent coronary artery bypass graft, aortic surgery, valve surgery, or a combination of these procedures were examined. Patients were randomly selected from the Nationwide Inpatient Sample database between 1998 and 2013 and included 11,359 participants with OUD (mean age, 47.67 years; 70.8% men) and 5,707,193 without OUD (mean age, 65.53 years; 68.0% men). Primary outcomes were complications, in-hospital mortality, costs, length of stay, and discharge disposition. Propensity matching allowed a direct comparison between the 2 groups.
The OUD prevalence was 0.2% in the entire cohort, reflecting an 8-fold rise during the 15-year study period (0.06% in 1998 to 0.54% in 2013; difference, 0.48%; 95% CI, 0.45-0.51; P <.001). Individuals with vs without OUD were more frequently male (P <.001), younger (P <.001), Hispanic (9.1% vs 4.8%, respectively) or black (13.7% vs 4.8%, respectively), and uninsured or on Medicaid (48.6% vs 7.7%, respectively; P <.001), with median income falling in the first quartile (30.7% vs 17.1%, respectively; P <.001). Aortic and valve procedures were performed more frequently in patients with vs without OUD (49.8% vs 16.4%, respectively; P <.001).
Overall mortality was comparable in patients with vs without OUD in the adjusted analysis (3.1% vs 4.0%, respectively; P =.12), but patients with vs without OUD had higher complication rates (67.6% vs 59.2%, respectively; P <.001). Complications included pulmonary embolism (7.3% vs 3.8%, respectively; P <.001), blood transfusion (30.4% vs 25.9%, respectively; P =.002), prolonged postoperative pain (2.0% vs 1.2%, respectively; P =.048), and need for mechanical ventilation (18.4% vs 15.7%, respectively; P =.02). In addition, those with vs without OUD had longer hospital stays (median days, 11 vs 10, respectively; P <.001) and incurred greater costs (median cost, $49,790 vs $45,216, respectively; P <.001). Mortality risk was also elevated in patients with OUD of Hispanic (odds ratio, 2.07; 95% CI, 1.46-2.93; P <.001) or black (odds ratio, 1.71; 95% CI, 1.27-2.30; P =.02) ethnicity.
Study limitations included a lack of availability of specific clinical information, inability to determine the causes of OUD-related complications, potential underreporting of OUD prevalence, and the possibility that there were inconsistencies in defining opioid use and dependence across healthcare facilities.
“Patients should not be denied surgery because of OUD status but should be carefully monitored postoperatively for complications,” noted the study authors. They recommended that future studies examine operative factors and a set of clinical outcomes to help formulate guidelines for this patient population.
Dewan KC, Dewan KS, Idrees JJ, et al. Trends and outcomes of cardiovascular surgery in patients with opioid use disorders [published online December 5, 2018]. JAMA Surg. doi:10.1001/jamasurg.2018.4608