Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery
Background Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting. Questions/purposes We s...
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| Veröffentlicht in: | Clinical orthopaedics and related research 2015-07, Vol.473 (7), p.2402-2412 |
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| description | Background
Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting.
Questions/purposes
We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.
Methods
We used coding data collected in discharge records from the Nationwide Inpatient Sample (2002–2011). We analyzed changes with time in the prevalence of opioid abuse and dependence on admission. Finally, we used multivariate regression modeling to measure the association of opioid abuse and dependence with in-hospital postoperative mortality, morbidity, and resource utilization, and to identify factors associated with high-risk opioid use.
Results
The prevalence of opioid abuse and dependence increased from 0.095% in 2002 to 0.24% in 2011, an increase of 152% (p |
| doi_str_mv | 10.1007/s11999-015-4173-5 |
| format | Article |
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Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting.
Questions/purposes
We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.
Methods
We used coding data collected in discharge records from the Nationwide Inpatient Sample (2002–2011). We analyzed changes with time in the prevalence of opioid abuse and dependence on admission. Finally, we used multivariate regression modeling to measure the association of opioid abuse and dependence with in-hospital postoperative mortality, morbidity, and resource utilization, and to identify factors associated with high-risk opioid use.
Results
The prevalence of opioid abuse and dependence increased from 0.095% in 2002 to 0.24% in 2011, an increase of 152% (p < 0.001). Opioid abuse and dependence were associated with increased inpatient mortality (odds ratio [OR], 3.7; 95% CI, 2.7–5.1) and aggregate morbidity (OR, 2.3 l; 95% CI, 2.2–2.4), including induced mental disorder (OR, 5.9; 95% CI, 5.4–6.3), respiratory failure (OR, 3.1; 95% CI, 2.7–3.6), surgical site infection (OR, 2.5; 95% CI, 2.0–3.0), mechanical ventilation (OR, 2.3; 95% CI, 2.0–2.5), pneumonia (OR, 2.1; 95% CI, 1.8–2.3), myocardial infarction (OR, 1.9; 95% CI, 1.3–2.6), and postoperative ileus or other gastrointestinal events (OR, 1.4; 95% CI, 1.3–1.6) (p < 0.001 for all listed entities). Abuse and dependence also were associated with increased risk for prolonged hospital length of stay (OR, 2.5; 95% CI, 2.4–2.5), nonroutine discharge (OR, 2.2; 95% CI, 2.2–2.3), and failure to rescue (OR, 2.0; 95% CI, 1.4–2.8). High-risk opioid users were more likely to be younger, male, nonwhite, Medicaid-insured patients with mental health and substance use disorders, and to be undergoing spine surgery. Hospital-related characteristics included urban setting, geographic location in the Northeast or West, and serving as a teaching facility.
Conclusion
Opioid abuse and dependence are increasing rapidly among orthopaedic surgical inpatients and are associated with considerable postoperative morbidity and mortality and resource utilization. We recommend that orthopaedic surgeons screen patients carefully for opioid misuse preoperatively, help patients who are using opioids inappropriately to discontinue them before scheduling elective surgery, decline to perform elective surgery in patients who misuse opioids, and closely monitor patients who are habituated to opioids at the time they undergo surgery.
Level of Evidence
Level III, prognostic study.</description><identifier>ISSN: 0009-921X</identifier><identifier>EISSN: 1528-1132</identifier><identifier>DOI: 10.1007/s11999-015-4173-5</identifier><identifier>PMID: 25694266</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Clinical Research ; Conservative Orthopedics ; Cross-Sectional Studies ; Elective Surgical Procedures - mortality ; Female ; Hospital Mortality ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Opioid-Related Disorders - complications ; Opioid-Related Disorders - epidemiology ; Orthopedic Procedures - mortality ; Orthopedics ; Postoperative Complications - etiology ; Postoperative Complications - mortality ; Prevalence ; Retrospective Studies ; Sports Medicine ; Surgery ; Surgical Orthopedics</subject><ispartof>Clinical orthopaedics and related research, 2015-07, Vol.473 (7), p.2402-2412</ispartof><rights>The Association of Bone and Joint Surgeons® 2015</rights><rights>The Association of Bone and Joint Surgeons 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c529t-4b56a709988a65631f0822457eaea3c81a38f4f9e84cece07a864ef4a35265df3</citedby><cites>FETCH-LOGICAL-c529t-4b56a709988a65631f0822457eaea3c81a38f4f9e84cece07a864ef4a35265df3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4457771/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4457771/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,41464,42533,51294,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25694266$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Menendez, Mariano E.</creatorcontrib><creatorcontrib>Ring, David</creatorcontrib><creatorcontrib>Bateman, Brian T.</creatorcontrib><title>Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery</title><title>Clinical orthopaedics and related research</title><addtitle>Clin Orthop Relat Res</addtitle><addtitle>Clin Orthop Relat Res</addtitle><description>Background
Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting.
Questions/purposes
We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.
Methods
We used coding data collected in discharge records from the Nationwide Inpatient Sample (2002–2011). We analyzed changes with time in the prevalence of opioid abuse and dependence on admission. Finally, we used multivariate regression modeling to measure the association of opioid abuse and dependence with in-hospital postoperative mortality, morbidity, and resource utilization, and to identify factors associated with high-risk opioid use.
Results
The prevalence of opioid abuse and dependence increased from 0.095% in 2002 to 0.24% in 2011, an increase of 152% (p < 0.001). Opioid abuse and dependence were associated with increased inpatient mortality (odds ratio [OR], 3.7; 95% CI, 2.7–5.1) and aggregate morbidity (OR, 2.3 l; 95% CI, 2.2–2.4), including induced mental disorder (OR, 5.9; 95% CI, 5.4–6.3), respiratory failure (OR, 3.1; 95% CI, 2.7–3.6), surgical site infection (OR, 2.5; 95% CI, 2.0–3.0), mechanical ventilation (OR, 2.3; 95% CI, 2.0–2.5), pneumonia (OR, 2.1; 95% CI, 1.8–2.3), myocardial infarction (OR, 1.9; 95% CI, 1.3–2.6), and postoperative ileus or other gastrointestinal events (OR, 1.4; 95% CI, 1.3–1.6) (p < 0.001 for all listed entities). Abuse and dependence also were associated with increased risk for prolonged hospital length of stay (OR, 2.5; 95% CI, 2.4–2.5), nonroutine discharge (OR, 2.2; 95% CI, 2.2–2.3), and failure to rescue (OR, 2.0; 95% CI, 1.4–2.8). High-risk opioid users were more likely to be younger, male, nonwhite, Medicaid-insured patients with mental health and substance use disorders, and to be undergoing spine surgery. Hospital-related characteristics included urban setting, geographic location in the Northeast or West, and serving as a teaching facility.
Conclusion
Opioid abuse and dependence are increasing rapidly among orthopaedic surgical inpatients and are associated with considerable postoperative morbidity and mortality and resource utilization. We recommend that orthopaedic surgeons screen patients carefully for opioid misuse preoperatively, help patients who are using opioids inappropriately to discontinue them before scheduling elective surgery, decline to perform elective surgery in patients who misuse opioids, and closely monitor patients who are habituated to opioids at the time they undergo surgery.
Level of Evidence
Level III, prognostic study.</description><subject>Clinical Research</subject><subject>Conservative Orthopedics</subject><subject>Cross-Sectional Studies</subject><subject>Elective Surgical Procedures - mortality</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Opioid-Related Disorders - complications</subject><subject>Opioid-Related Disorders - epidemiology</subject><subject>Orthopedic Procedures - mortality</subject><subject>Orthopedics</subject><subject>Postoperative Complications - etiology</subject><subject>Postoperative Complications - mortality</subject><subject>Prevalence</subject><subject>Retrospective Studies</subject><subject>Sports Medicine</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><issn>0009-921X</issn><issn>1528-1132</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkV9rFDEUxYModq1-AF8k4Isvo_k_yYuwlKqFlgoq-haymTvdlNnJmGQK--3NdmqpgkgewuH-cu7NPQi9pOQtJaR9lyk1xjSEykbQljfyEVpRyXRDKWeP0YoQYhrD6I8j9Czn6yq5kOwpOmJSGcGUWqH0OUGcILkSbgBfTiGGDl-EPGfAIeN1ztEHV6DD30PZ4rPRJ3C5youYNqELZY_deKuKGw5q3RdI-HQAvzimso2Tgy54_GVOV5D2z9GT3g0ZXtzdx-jbh9OvJ5-a88uPZyfr88ZLZkojNlK5lhijtVNScdoTzZiQLThw3GvquO5Fb0ALDx5I67QS0AvHJVOy6_kxer_4TvNmB52HsSQ32CmFnUt7G12wf1bGsLVX8caK2qRtaTV4c2eQ4s8ZcrG7kD0MgxshztlSzXhdo1bs_6iqw9F6TEVf_4VexzmNdRO3FDWakwNFF8qnmHOC_n5uSuwhfLuEb2v49hC-lfXNq4cfvn_xO-0KsAXItTTWLB60_qfrL_Uju6k</recordid><startdate>20150701</startdate><enddate>20150701</enddate><creator>Menendez, Mariano E.</creator><creator>Ring, David</creator><creator>Bateman, Brian T.</creator><general>Springer US</general><general>Lippincott Williams & Wilkins Ovid Technologies</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>7U7</scope><scope>C1K</scope><scope>5PM</scope></search><sort><creationdate>20150701</creationdate><title>Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery</title><author>Menendez, Mariano E. ; Ring, David ; Bateman, Brian T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c529t-4b56a709988a65631f0822457eaea3c81a38f4f9e84cece07a864ef4a35265df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Clinical Research</topic><topic>Conservative Orthopedics</topic><topic>Cross-Sectional Studies</topic><topic>Elective Surgical Procedures - mortality</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Opioid-Related Disorders - complications</topic><topic>Opioid-Related Disorders - epidemiology</topic><topic>Orthopedic Procedures - mortality</topic><topic>Orthopedics</topic><topic>Postoperative Complications - etiology</topic><topic>Postoperative Complications - mortality</topic><topic>Prevalence</topic><topic>Retrospective Studies</topic><topic>Sports Medicine</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Menendez, Mariano E.</creatorcontrib><creatorcontrib>Ring, David</creatorcontrib><creatorcontrib>Bateman, Brian T.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical orthopaedics and related research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Menendez, Mariano E.</au><au>Ring, David</au><au>Bateman, Brian T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery</atitle><jtitle>Clinical orthopaedics and related research</jtitle><stitle>Clin Orthop Relat Res</stitle><addtitle>Clin Orthop Relat Res</addtitle><date>2015-07-01</date><risdate>2015</risdate><volume>473</volume><issue>7</issue><spage>2402</spage><epage>2412</epage><pages>2402-2412</pages><issn>0009-921X</issn><eissn>1528-1132</eissn><abstract>Background
Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting.
Questions/purposes
We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.
Methods
We used coding data collected in discharge records from the Nationwide Inpatient Sample (2002–2011). We analyzed changes with time in the prevalence of opioid abuse and dependence on admission. Finally, we used multivariate regression modeling to measure the association of opioid abuse and dependence with in-hospital postoperative mortality, morbidity, and resource utilization, and to identify factors associated with high-risk opioid use.
Results
The prevalence of opioid abuse and dependence increased from 0.095% in 2002 to 0.24% in 2011, an increase of 152% (p < 0.001). Opioid abuse and dependence were associated with increased inpatient mortality (odds ratio [OR], 3.7; 95% CI, 2.7–5.1) and aggregate morbidity (OR, 2.3 l; 95% CI, 2.2–2.4), including induced mental disorder (OR, 5.9; 95% CI, 5.4–6.3), respiratory failure (OR, 3.1; 95% CI, 2.7–3.6), surgical site infection (OR, 2.5; 95% CI, 2.0–3.0), mechanical ventilation (OR, 2.3; 95% CI, 2.0–2.5), pneumonia (OR, 2.1; 95% CI, 1.8–2.3), myocardial infarction (OR, 1.9; 95% CI, 1.3–2.6), and postoperative ileus or other gastrointestinal events (OR, 1.4; 95% CI, 1.3–1.6) (p < 0.001 for all listed entities). Abuse and dependence also were associated with increased risk for prolonged hospital length of stay (OR, 2.5; 95% CI, 2.4–2.5), nonroutine discharge (OR, 2.2; 95% CI, 2.2–2.3), and failure to rescue (OR, 2.0; 95% CI, 1.4–2.8). High-risk opioid users were more likely to be younger, male, nonwhite, Medicaid-insured patients with mental health and substance use disorders, and to be undergoing spine surgery. Hospital-related characteristics included urban setting, geographic location in the Northeast or West, and serving as a teaching facility.
Conclusion
Opioid abuse and dependence are increasing rapidly among orthopaedic surgical inpatients and are associated with considerable postoperative morbidity and mortality and resource utilization. We recommend that orthopaedic surgeons screen patients carefully for opioid misuse preoperatively, help patients who are using opioids inappropriately to discontinue them before scheduling elective surgery, decline to perform elective surgery in patients who misuse opioids, and closely monitor patients who are habituated to opioids at the time they undergo surgery.
Level of Evidence
Level III, prognostic study.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>25694266</pmid><doi>10.1007/s11999-015-4173-5</doi><tpages>11</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Clinical orthopaedics and related research, 2015-07, Vol.473 (7), p.2402-2412 |
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| source | MEDLINE; Springer Nature - Complete Springer Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Clinical Research Conservative Orthopedics Cross-Sectional Studies Elective Surgical Procedures - mortality Female Hospital Mortality Humans Male Medicine Medicine & Public Health Middle Aged Opioid-Related Disorders - complications Opioid-Related Disorders - epidemiology Orthopedic Procedures - mortality Orthopedics Postoperative Complications - etiology Postoperative Complications - mortality Prevalence Retrospective Studies Sports Medicine Surgery Surgical Orthopedics |
| title | Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery |
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