Opioid Use and Overdose Risk After Discharge From Surgery in the VA
The incidence of overdose was 26.3 events per person-year (68 events) in the first 30 days after hospital discharge.
A study published in Pain Medicine found that people undergoing surgery at the Veterans Health Administration were 11 times more likely to experience opioid overdose in the first 30 days postdischarge than during the remaining days of the year following surgery.
This retrospective cohort study sought to determine the association between postdischarge opioid use (ongoing and newly started) and risk for opioid overdose and delirium among Veterans Health Administration patients who underwent surgery in 2011. A total of 64,391 patients were followed for 365 days after surgery and were categorized according to their opioid use: no opioids, tramadol only, short-acting opioids only, long-acting opioids only, both short- and long-acting opioids.
The incidence of overdose was 26.3 events per person-year (68 events) in the first 30 days after hospital discharge compared with an incidence rate of 2.4 events per person-year (476 events) in the period lasting from 31 to 365 days postdischarge, corresponding to an incidence rate ratio of 10.80.
Use of any opioid was strongly associated with elevated risk for overdose during both study intervals. Higher-intensity opioid use was associated with higher risk for overdose in the year after surgery, with patients prescribed short- and long-acting opioids at greatest risk (hazard ratio, 4.84; 95% CI, 3.28-7.14). Furthermore, drug delirium was associated with higher opioid intensity (incidence rate ratio=10.66). The risk for overdose was comparable across surgery types.
Study limitations include the decisions to use medication dispensing data rather than medications taken and not to categorize overdoses occurring from therapeutic use vs misuse.
“As surgery may be followed by sustained postdischarge opioid use, it may be necessary to improve provider education — including surgeon and hospitalist education — so that patients are maintained on the lowest effective intensity of opioids possible to minimize risks of overdose,” concluded the study authors.
Mudumbai S, et al. Overdose risk associated with opioid use upon hospital discharge in Veterans Health Administration surgical patients [published online August 21, 2018]. Pain Med. doi: 10.1093/pm/pny150