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Health-System Analysis: Higher Postsurgical Opioid Use Linked to Extended Hospital Stay and Increased Cost of Care

Experts advise starting with non-opioid medication (Dec. 18)

The results of a recent health-system analysis to quantify the relationship among opioid use, total hospital charges, and patient length of stay (LOS) have been published in Hospital Pharmacy. The study found that, in addition to increased hospital charges, patients undergoing total abdominal hysterectomy (TAH) with an unusually long LOS (5 days or more) had a higher incidence of opioid-related adverse events (ORAEs) compared with control patients with a more typical LOS (fewer than 5 days).

In the study, medical records of patients undergoing TAH were reviewed to identify LOS “outliers” — patients with an LOS lasting 5 days or longer. The researchers matched 97 LOS outliers with an equal number of control patients who had an LOS of fewer than 5 days and similar baseline characteristics. Comparisons between the two groups showed that LOS outliers:

  • Remained hospitalized 5.5 days longer than controls
  • Had $8,544 more in total hospital charges than control patients ($14,289 vs. $5,745, respectively)
  • Received more than twice the total opioid dose compared with controls by the time of discharge
  • Reported a markedly higher incidence of ORAEs compared with controls (gastrointestinal ORAEs occurred in 44% of outliers compared with 19% of control patients, and respiratory ORAEs occurred in 12% of outliers compared with 1% of controls [both P < 0.01])

Although potent analgesics, opioids are associated with a range of unwanted and potentially life-threatening adverse events, including nausea, vomiting, constipation, urinary retention, and respiratory depression. A recent alert issued by the Joint Commission details the risk for opioid-induced over-sedation and respiratory depression in certain patient populations and recommends a multimodal approach to postsurgical pain management. The Joint Commission advises that, upon individual patient assessment, the best approach may be to start with a non-opioid medication.

Source: Pacira Pharmaceuticals; December 18, 2012.

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