Persistent Opioid Use After Open Aortic Surgery: Risk Factors, Costs, and Consequences

Area of Science:

• Cardiovascular Surgery
• Pain Management
• Health Economics

Background:

• Persistent opioid use (POU) following open aortic surgery remains undefined.
• Understanding the incidence and financial implications of POU is crucial for patient care and healthcare system management.

Purpose of the Study:

• To determine the incidence of POU after open aortic surgery.
• To identify risk factors associated with POU.
• To quantify the financial impact of POU on postoperative healthcare costs.

Main Methods:

• Analysis of insurance claims data for opioid-naïve patients undergoing specific open aortic procedures (2011-2017).
• Definition of POU based on prescription filling within the perioperative and 90-180 day postoperative periods.
• Quantification of opioid prescriptions, emergency department visits, readmissions, and healthcare costs, with multivariable logistic and quantile regression for risk factor and cost impact analysis.

Main Results:

• POU was identified in 5.2% of 3240 patients.
• Patients with POU received more perioperative opioids, had higher rates of emergency department visits (45.6% vs 25.4%), and incurred significantly higher 6-month postoperative healthcare costs ($10,947 vs $7223).
• Independent risk factors for POU included preoperative nicotine use and higher initial perioperative opioid prescription amounts. POU was associated with an average $2439 increase in 6-month postoperative healthcare costs.

Conclusions:

• POU presents a significant challenge after open aortic surgery.
• POU is linked to increased healthcare payments and emergency department visits in the six months following surgery.
• Implementing strategies to minimize outpatient opioid use after aortic surgery is advisable.