Health Care Spending and New Persistent Opioid Use After Surgery

Abstract

Objective: We sought to describe the differences in health care spending and utilization among patients who develop persistent postoperative opioid use.

Summary of background data: Although persistent opioid use following surgery has garnered concern, its impact on health care costs and utilization remains unknown.

Methods: We examined insurance claims among 133,439 opioid-naive adults undergoing surgery. Outcomes included 6-month postoperative health care spending; proportion of spending attributable to admission, readmission, ambulatory or emergency care; monthly spending 6 months before and following surgery. We defined persistent opioid use as continued opioid fills beyond 3 months postoperatively. We used linear regression to estimate outcomes adjusting for clinical covariates.

Results: In this cohort, 8103 patients developed persistent opioid use. For patients who underwent inpatient procedures, new persistent opioid use was associated with health care spending (+$2700 per patient, P < 0.001) compared with patients who did not develop new persistent use. For patients who underwent outpatient procedures, new persistent opioid use was similarly correlated with higher health care spending (+$1500 per patient, P < 0.001) compared with patients who did not develop new persistent use. Patients without persistent opioid use returned to baseline health care spending within 6 months, regardless of other complications. However, patients with persistent opioid use had sustained increases in spending by approximately $200 per month.

Conclusion: Unlike other postoperative complications, persistent opioid use is associated with sustained increases in spending due to greater readmissions and ambulatory care visits. Early identification of patients vulnerable to persistent use may enhance the value of surgical care.

EXHIBIT 2 (Figure):

Adjusted total healthcare spending for new persistent opioid use. Source/Notes: SOURCE Author’s analysis of data from [Optum Clinformatics Data Mart, 2008 – 2015]. NOTES For patients who underwent inpatient procedures, new persistent opioid use was independently associated with significantly higher adjusted total healthcare spending. Healthcare spending was significantly higher for patients without other complications (+$2,500, P < 0.001) and with other complications (+$6,600, P < 0.001). For patients who underwent outpatient procedures, new persistent opioid use was also independently associated with significantly higher adjusted total healthcare spending. Healthcare spending was significantly higher for patients without other complications (+$1,000, P < 0.001) and with other complications (+$5,900, P < 0.001).

EXHIBIT 3 (Figure):

Total healthcare spending for different types of care for new persistent opioid use Source/Notes: SOURCE Author’s analysis of data from [Optum Clinformatics Data Mart, 2008 – 2015]. NOTES New persistent opioid use was associated with a significantly higher proportion of healthcare spending attributed to ambulatory care and readmissions, while the proportion of healthcare spending attributed to the index encounter was significantly lower. These findings were consistent for inpatient procedures, outpatient procedures, and patient with and without other complications.

EXHIBIT 4 (Figure):

Adjusted monthly healthcare spending for new persistent opioid use Source/Notes: SOURCE Author’s analysis of data from [Optum Clinformatics Data Mart, 2008 – 2015]. NOTES For inpatient procedures (Exhibit 4A), all patients had similar adjusted monthly healthcare spending before surgery. Patients without new persistent opioid use or other complications returned to baseline levels of adjusted monthly healthcare spending 180 days after surgery. In contrast, patients with new persistent opioid use only (without other complications) had a sustained increase in adjusted monthly healthcare spending 180 days after surgery (+$200 per month, P<0.001). Patients with other complications only (without new persistent opioid use) returned to baseline levels of monthly healthcare spending by 180 days after surgery. Patients with both new persistent opioid use and other complications also had a sustained increase in adjusted monthly healthcare spending 180 days after surgery. The same trends were observed for patients undergoing outpatient procedures (Exhibit 4B). Specifically, all patients had similar levels of adjusted monthly healthcare spending before surgery. Patients without new persistent opioid use or other complications returned to baseline levels of adjusted monthly healthcare spending 180 days after surgery. In contrast, patients with new persistent opioid use only (without other complications) had a sustained increase in adjusted monthly healthcare spending (+$200 per month, P<0.001) 180 days after surgery. Patients with other complications only (without new persistent opioid use) returned to baseline levels of adjusted monthly healthcare spending by 180 days after surgery. Patients with both new persistent opioid use and other complications also had a sustained increase in adjusted monthly healthcare spending 180 days after surgery.