scholarly journals Preexisting Opioid Use Disorder and Outcomes After Lower Extremity Arthroplasty: A Multistate Analysis, 2007–2014

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3624-3634
Author(s):  
Stephanie A Chen ◽  
Robert S White ◽  
Virginia Tangel ◽  
Soham Gupta ◽  
Jeffrey B Stambough ◽  
...  
Keyword(s):  
Health Care ◽  
Risk Factor ◽  
Postoperative Complications ◽  
Lower Extremity ◽  
Health Care Utilization ◽  
Hospital Mortality ◽  
Opioid Use Disorder ◽  
Care Utilization ◽  
Opioid Use ◽  
Present On Admission

Abstract Objective The aim of this study was to examine the association of preexisting opioid use disorder and postoperative outcomes in patients undergoing total hip or knee arthroplasty (THA and TKA, respectively) in the overall population and in the Medicare-only population. Methods This retrospective cohort study examined data from the State Inpatient Databases of the Healthcare Cost and Utilization Project for the years 2007–2014 from California, Florida, New York, Maryland, and Kentucky. We compared patients with and without opioid use disorders on unadjusted rates and calculated adjusted odds ratios (aORs) of in-hospital mortality, postoperative complications, length of stay, and 30-day and 90-day readmission status; analyses were repeated in a subgroup of Medicare insurance patients only. Subjects After applying our exclusion criteria, our study included 1,422,210 adult patients undergoing lower extremity arthroplasties, including 818,931 Medicare insurance patients. In our study, 0.4% of THA patients and 0.3% of TKA patients had present-on-admission opioid use disorder. Results Opioid use disorder patients were at higher risk for in-hospital mortality (aOR = 3.10), 30- and 90-day readmissions (aORs = 1.81, 1.81), and pulmonary and infectious complications (aORs = 1.25, 1.96). Conclusions Present-on-admission opioid use disorder was a risk factor for worse postoperative outcomes and increased health care utilization in the lower extremity arthroplasty population. Opioid use disorder is a potentially modifiable risk factor for mortality, postoperative complications, and health care utilization, especially in the at-risk Medicare population.

scholarly journals Health care utilization and overall costs based on opioid dependence in patients undergoing surgery for degenerative spondylolisthesis

2018 ◽  
Vol 44 (5) ◽  
pp. E14 ◽  
Author(s):  
Mayur Sharma ◽  
Beatrice Ugiliweneza ◽  
Zaid Aljuboori ◽  
Maxwell Boakye
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Opioid Dependence ◽  
Degenerative Spondylolisthesis ◽  
Opioid Use Disorder ◽  
Hospital Length Of Stay ◽  
Care Utilization ◽  
Opioid Use ◽  
Opioid Dependency ◽  
Linear Contrasts

OBJECTIVEOpioid abuse is highly prevalent in patients with back pain. The aim of this study was to identify health care utilization and overall costs associated with opioid dependence in patients undergoing surgery for degenerative spondylolisthesis (DS).METHODSThe authors queried the MarketScan database using ICD-9 and CPT-4 codes from 2000 to 2012. Opioid dependency was defined as having a diagnosis of opioid use disorder, having a prescription for opioid use disorder, or having 10 or more opioid prescriptions. Opioid dependency was evaluated in 12-month period leading to surgery and in the period 3–15 months following the procedure. Patients were segregated into 4 groups based on opioid dependence before and after surgery: group NDND (prior nondependent who remain nondependent), group NDD (prior nondependent who become dependent), group DND (prior dependent who become nondependent), and group DD (prior dependent who remain dependent). The outcomes of interest were discharge disposition, hospital length of stay (LOS), complications, and health care resource costs. The 4 groups were compared using the Kruskal-Wallis test and linear contrasts built from generalized regression models.RESULTSA total of 10,708 patients were identified, with 81.57%, 3.58%, 8.54%, and 6.32% of patients in groups NDND, NDD, DND, and DD, respectively. In group DD, 96.31% of patients had decompression with fusion, compared with 93.59% in group NDND. Patients in group NDD, DND, and DD had longer hospital LOS compared with those in group NDND. Patients in group DD were less likely to be discharged home compared with those in group NDND (odds ratio 0.639, 95% confidence interval 0.52–0.785). At 3–15 months postdischarge, patients in group DD incurred 21% higher hospital readmission costs compared with those in group NDND. However, patients in groups NDD and DD were likely to incur 2.8 times the overall costs compared with patients in group NDND (p < 0.001) at 3–15 months after surgery (median overall payments: group NDD $20,033 and group DD $19,654, vs group NDND $7994).CONCLUSIONSPatients who continued to be opioid dependent or became opioid dependent following surgery for DS incurred significantly higher health care utilization and costs within 3 months and in the period 3–15 months after discharge from surgery.

scholarly journals Relapse In Opioid Use Disorder: Implications For Health Care Utilization And Costs

2016 ◽  
Vol 19 (3) ◽  
pp. A188 ◽  
Author(s):  
B Brady ◽  
J Tkacz ◽  
V Nadipelli ◽  
J Volpicelli ◽  
N Ronquest ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Opioid Use Disorder ◽  
Care Utilization ◽  
Opioid Use

Pre-existing opioid use disorder and postoperative outcomes after appendectomy or cholecystectomy: A multi-state analysis, 2007-2014

2019 ◽  
Vol 15 (3) ◽  
pp. 235-251
Author(s):  
Alina Boltunova, MD ◽  
Robert S. White, MD, MS ◽  
Selaiman Noori, MD ◽  
Stephanie A. Chen, BA ◽  
Licia K. Gaber-Baylis, BA ◽  
...  
Keyword(s):  
New York ◽  
Postoperative Complications ◽  
Hospital Mortality ◽  
Hospital Readmission ◽  
Opioid Use Disorder ◽  
Postoperative Outcomes ◽  
Hospital Length Of Stay ◽  
Hospital Death ◽  
Surgical Patient ◽  
Opioid Use

Introduction and objectives: Opioid use disorder has become increasingly prevalent in recent years. Previous studies have shown that patients with opioid use disorder undergoing orthopedic, elective abdominopelvic, and cardiac procedures have poorer postoperative outcomes. The aim of this study was to examine the effect of pre-existing opioid use disorder on postoperative outcomes including in-hospital mortality, hospital length of stay (LOS), hospital readmission, and postoperative complications in patients undergoing appendectomy or cholecystectomy.Methods: The authors used administrative data from the State Inpatient Databases of the Healthcare Cost and Utilization Project for the years 2007-2014 from California, Florida, Kentucky, Maryland, and New York. The authors compared unadjusted rates of in-hospital mortality, postoperative complications, LOS, and 30-day and 90-day readmission status. The authors calculated the adjusted odds ratio (OR) for their outcomes using logistic regression models.Results: In all, 488,981 appendectomy patients and 790,491 cholecystectomy patients aged ≥ 18 years were included in the analysis. Appendectomy (OR 2.26) but not cholecystectomy patients with opioid use disorder had statistically significant adjusted odds of in-hospital death. Patients with opioid use disorder (overall reported, and by each procedure separately) had higher adjusted odds of postoperative complication (OR 1.46), 30-day readmission (OR 1.80), 90-day readmission (OR 1.98), and longer LOS (OR 1.37).Conclusions: The authors found higher unadjusted rates and adjusted ORs of in-patient mortality, hospital readmission, and postoperative complications in patients with opioid use disorder undergoing common abdominal surgeries. The authors’ study shows that opioid use disorder is a risk factor for poorer postoperative outcomes in this surgical patient population.

Short-Term Absenteeism and Health Care Utilization Due to Lower Extremity Injuries Among Novice Runners

2016 ◽  
Vol 26 (6) ◽  
pp. 502-509 ◽  
Author(s):  
Dirk-Wouter Smits ◽  
Bionka Huisstede ◽  
Evert Verhagen ◽  
Henk van der Worp ◽  
Bas Kluitenberg ◽  
...  
Keyword(s):  
Health Care ◽  
Lower Extremity ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Short Term ◽  
Lower Extremity Injuries ◽  
Extremity Injuries
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