Pre-Operative Opioid Use Increases Costs, Hospitalization

A new study finds that while receiving an opioid prescription after surgery is common, patients who take opioids prior to the procedure may experience adverse events.

Investigators discovered that patients taking opioids before abdominal surgery had longer hospital stays and increased readmissions or rehabilitative care compared with those who did not take the drugs prior to the operation, according to a study published by the Annals of Surgery.

This higher need for care doubled or tripled costs for patients taking opioids, with higher doses translating to higher costs.

These findings, in addition to past studies, suggest that pre-operative opioid use should be advised against due to increased risks.

“We often pause when we are considering elective surgery with a patient, based on known risk factors such as smoking, anticoagulant use, and overall medical conditions,” said lead study author Jennifer Waljee, MD, MS. “These findings suggest that perhaps preoperative opioid use warrants the same awareness.”

The study authors suggest that patients and physicians should discuss tapering opioid use, or an alternative pain relief approach should be considered prior to elective abdominal surgery.

“Physicians should make a plan to manage the patient's pain during the perioperative period that takes into account their past opioid use,” Dr Waljee said.

Due to other findings that chronic opioid use can increase sensitivity to pain, physicians should take past use into consideration, since it can impact pain levels post-surgery.

Prior to conducting the study, the authors discovered a similar trend in Michigan hospitals, and found that patients who used opioids prior to surgery had an increased likelihood of complications, readmissions, and higher costs.

In the new study, researchers used national claims data from private insurance companies, including 200,000 middle-class Americans who underwent hysterectomies, bariatric surgery, hernia repair, and reflux surgery. All patients spent at least 1 night recovering in the hospital.

Of those included, 9% filled at least 2 opioid prescriptions within 90 days before their operation, with 1 fill occurring within a month of the surgery. These patients were more likely to have a medical history of psychological conditions, compared with non-opioid users, according to the study.

Patients taking opioids prior to surgery spent an extra half-day in the hospital after the operation, regardless of other factors, according to the study. The authors also reported that those patients were more likely to be readmitted or treated at a rehabilitation facility within 30 days.

However, the rate of readmission was not substantial — 4.5% of opioid users were readmitted, while 3.6% of non-opioid users were readmitted; however, the costs made a significant difference.

Within the first 90 days after surgery, patients taking opioids had medical costs 3 times as high as those who had not taken the drugs before surgery. At 1 year, the medical costs for pre-surgery opioid users was approximately $25,000, which was more than double the $12,113 incurred by non-opioid users, according to the study.

These findings show that patients who use opioids long-term may receive more medical care and have more medical costs than patients who do not. Prior to surgery, physicians may choose to modify patients’ prescription drug regimen to ensure beneficial outcomes.

"The bottom line is that preoperative opioid use is an important and potentially modifiable risk factor prior to surgery, and should be on surgeons' radar as well as the minds of primary care providers," Dr Waljee concluded. "Coordinating care throughout the surgical period could improve clinical outcomes and the patient experience."