Long-acting opioids before surgery tied to extended LOS, readmission

  • Doan LV & al.
  • Pain Med
  • 25 Feb 2019

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Patients who received preoperative long-acting opioids before undergoing elective, noncardiac surgery had a longer LOS for inpatient surgeries and higher readmission rates for outpatient surgeries compared with opioid-naive patients.
  • There were no significant differences between groups in rates of postoperative respiratory failure or major adverse cardiac events.

Why this matters

  • The effect of preoperative long-acting opioid use on postoperative outcomes was unclear.

Study design

  • Retrospective cohort study evaluated postoperative outcomes in 93,644 patients who underwent elective noncardiac surgeries and were either long-acting opioid users or were opioid-naive.
  • Among included patients, 23,605 underwent inpatient surgeries and 70,039 underwent ambulatory surgeries.
  • Funding: Anesthesia Research Fund of the New York University School of Medicine.

Key results

  • Among inpatients, after adjusting for potential confounders, long-acting opioid use was significantly associated with prolonged postoperative hospital length of stay (incidence rate ratio, 1.1; P=.005).
  • No significant association observed between long-acting opioids and adverse cardiac events (P=.13) or respiratory failure (P=.17).
  • In patients undergoing ambulatory surgeries, long-acting opioids were significantly associated with hospital readmission (aOR, 2.1; P<.001>
  • No significant association was observed between long-acting opioids use and adverse cardiac events (P=.6).

Limitations

  • Single-center study.
  • Retrospective nature with possibility of confounding.

Coauthored with Antara Ghosh, PhD