Surgery patients often go home from the hospital with a prescription for painkillers to take as they recover. But a new study from the University of Michigan suggests that doctors should also focus on patients who were taking such medications before their operations.
People who received prescriptions for opioid painkillers in the months before elective abdominal procedures had longer hospital stays and a higher chance of needing follow-up care in a hospital or rehabilitation facility compared with patients who weren’t taking such medications before they had the same operations, the study found.
The extra care translated into higher costs for the patients’ postsurgery management––double or triple the amount, with higher opioid doses associated with higher costs. The findings were published in the April issue of the Annals of Surgery by a team at the University of Michigan Institute for Healthcare Policy and Innovation.
The new findings, and past research on the association between opioids and outcomes for other types of surgery, were enough to prompt the researchers to suggest that preoperative opioid use should be considered a preoperative risk factor.
For the new study, the authors used national claims data drawn from private insurance companies. They studied more than 200,000 middle-class Americans who had common operations––hysterectomies, bariatric surgery, hernia repair, and reflux surgery––during a 42-month period, and who spent at least one night in the hospital.
Approximately 9% of the patients had filled at least two opioid prescriptions within the 90 days before their operations––including at least one within a month before the operation. They tended to have more medical and psychological conditions compared with nonopioid patients.
The patients who had been prescribed opioids before surgery spent an average of an extra half a day in the hospital after their operations, the researchers found.
They also were more likely to end up back in the hospital or to go to a rehabilitation facility within 30 days after the operation––except for those taking the lowest possible doses. These difference weren’t huge––4.5% of opioid users had a hospital readmission compared with 3.6% of those who hadn’t taken opioids. But they were enough to make a difference in cost.
During the first 90 days after surgery, those who had been taking opioids had medical costs three times higher than those who hadn’t. The gap narrowed as time went on, but even at one year postsurgery, the presurgery opioid users had twice the medical costs (approximately $25,000) as had those who did not take the drugs (an average $12,113).
“The bottom line is that preoperative opioid use is an important and potentially modifiable risk factor prior to surgery, and should be on surgeons’ radar as well as the minds of primary care providers,” said lead author Jennifer Waljee, MD, MS. “Coordinating care throughout the surgical period could improve clinical outcomes and the patient experience.”
Source: University of Michigan; March 9, 2017.