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. 2024 Mar 13:18:111-116.
doi: 10.1016/j.sopen.2024.03.002. eCollection 2024 Mar.

Trends, outcomes, and factors associated with in-hospital opioid overdose following major surgery

Joanna Curry  1 , Troy Coaston  1 , Amulya Vadlakonda  1 , Sara Sakowitz  1 , Saad Mallick  1 , Nikhil Chervu  1   2 , Baran Khoraminejad  1 , Peyman Benharash  1   2
Affiliations

Trends, outcomes, and factors associated with in-hospital opioid overdose following major surgery

Joanna Curry et al. Surg Open Sci. .

Abstract

Background: With the growing opioid epidemic across the US, in-hospital utilization of opioids has garnered increasing attention. Using a national cohort, this study sought to characterize trends, outcomes, and factors associated with in-hospital opioid overdose (OD) following major elective operations.

Methods: We identified all adult (≥18 years) hospitalizations entailing select elective procedures in the 2016-2020 National Inpatient Sample. Patients who experienced in-hospital opioid overdose were characterized as OD (others: Non-OD). The primary outcome of interest was in-hospital OD. Multivariable logistic and linear regression models were developed to evaluate the association between in-hospital OD and mortality, length of stay (LOS), hospitalization costs, and non-home discharge.

Results: Of an estimated 11,096,064 hospitalizations meeting study criteria, 5375 (0.05 %) experienced a perioperative OD. Compared to others, OD were older (66 [57-73] vs 64 [54-72] years, p < 0.001), more commonly female (66.3 vs 56.7 %, p < 0.001), and in the lowest income quartile (26.4 vs 23.2 %, p < 0.001). After adjustment, female sex (Adjusted Odds Ratio [AOR] 1.68, 95 % Confidence Interval [CI] 1.47-1.91, p < 0.001), White race (AOR 1.19, CI 1.01-1.42, p = 0.04), and history of substance use disorder (AOR 2.51, CI 1.87-3.37, p < 0.001) were associated with greater likelihood of OD. Finally, OD was associated with increased LOS (β +1.91 days, CI [1.60-2.21], p < 0.001), hospitalization costs (β +$7500, CI [5900-9100], p < 0.001), and greater odds of non-home discharge (AOR 2.00, CI 1.61-2.48, p < 0.001).

Conclusion: Perioperative OD remains a rare but costly complication after elective surgery. While pain control remains a priority postoperatively, protocols and recovery pathways must be re-examined to ensure patient safety.

Keywords: National Inpatient Sample; Opioid overdose; Trends.

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Conflict of interest statement

The authors of this manuscript have no related conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flow diagram of study cohort of patients undergoing elective surgery. OD; opioid overdose, LOS; length of stay.
Fig. 2
Fig. 2
National trends in perioperative Opioid Overdose (OD) by United States Region, 2016–2020. Temporal trends overall, and in the Northeast and South were significant.
Fig. 3
Fig. 3
Incidence of Opioid Overdoses (OD) by surgical specialty.
Fig. 4
Fig. 4
Association of patient and hospital factors with the development of opioid overdose (OD) following elective procedures. Ref; Reference Group.
See this image and copyright information in PMC

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