Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related adverse events and their impact on clinical and economic outcomes

Study objective: To determine the prevalence of postsurgical opioid use in the inpatient setting, to ascertain the frequency of and risk factors for opioid-related adverse drug events (ORADEs) among patients who received opioids, and to evaluate the impact of ORADEs on clinical and economic outcomes.

Design: Retrospective cohort study using administrative data.

Setting: Hospital system encompassing 26 hospitals in the southeastern United States.

Patients: A total of 37,031 patients aged 18 years or older who underwent a common surgical procedure between January 1, 2009, and December 31, 2010.

Measurements and main results: Patients were evaluated for receipt of postsurgical opioids. Outcomes among opioid users included ORADE rates, hospital length of stay, total hospitalization costs, 30-day readmission rates, outlier status, and inpatient mortality. Factors associated with ORADEs were evaluated; length of stay, costs, readmissions, and mortality were compared between patients experiencing and not experiencing ORADEs by using propensity score matching on age, race-ethnicity, sex, presurgery opioid use, and comorbidities. Length of stay and cost rate ratios were generated by using negative binomial regression and generalized linear models. Odds ratios for 30-day readmissions and inpatient mortality were generated by using logistic regression. Among all surgical patients, 36,529 (98.6%) of patients received opioids, of whom 4955 (13.6%) experienced an ORADE. Increased risk of ORADEs was associated with age 65 years or older, male sex, obesity, presurgery opioid use, and higher score on Charlson Comorbidity Index. Patients with an ORADE had a 55% longer length of stay, 47% higher costs of care, 36% increased risk of 30-day readmission, and 3.4 times higher risk of inpatient mortality than did patients who did not experience an ORADE.

Conclusion: Opioid use was ubiquitous among hospitalized patients who underwent common surgical procedures. The observed negative outcomes of ORADEs and their impact on patients and the health care system should be considered when evaluating the balance between effectively managing postsurgical pain while minimizing the risk of ORADEs.