Patients with history of opioid use likely to have longer hospital stays

Surgery patients who have a history of opioid use before operations are more likely to have a longer hospital stay, and are more likely to be discharged to a rehab facility.

That’s according to Rebecca Busch, a resident surgeon at the UW-Madison Department of Surgery. She spoke recently at a university forum, where she presented data from a number of opioid-related studies from researchers around the country, also giving her perspective on the epidemic and what her colleagues can do to help fix it.

“Opioid-related adverse events are considered part of normal post-operative recovery,” she said, listing things like nausea, vomiting, constipation and opioid-induced sensitivity to pain.

“However, a retrospective cohort study revealed that patients with opioid-related adverse events had 55 percent longer hospital stays, 47 percent higher hospital costs, 36 percent higher risk of 30-day readmission, and 3.4-fold higher risk of patient mortality,” she said. “I find those numbers striking.”

To improve the situation, she says health care professionals should spend some time examining how preoperative opioid exposure affects health care procedures and expenditures. She said addressing opioid use among patients considering elective surgery in particular could provide “considerable value.”

She also said preoperative opioid use is correlated with a greater rate of 30-day readmission and overall greater expenditure at 90, 180, and 365 days following surgery.

By discussing opioid use the same way providers discuss smoking cessation, weight loss, diabetes management, and evaluation and treatment of cardiac disease, she says these numbers can be improved.

She also noted a follow-up study demonstrated that an education intervention could decrease opioid prescribing after general surgery operations.

“They simply discussed their findings and opioid prescribing guidelines with surgeons of their institution and recommended that surgeons coach patients to NSAIDs and Tylenol before using opioids,” she said. “They found that the mean number of opioid pills prescribed for each operation markedly decreased, and the total number of pills prescribed decreased 53 percent when compared to the number that would have been prescribed before the education intervention.”

She says this research “gives us hope that every discipline can markedly decrease opioid prescribing” by determining a reasonable opioid requirement for their operations, and then spreading that information to members within their specialty.

–By Alex Moe