Dallas, TX—Opioid-related adverse drug events occur more often than expected with hospital-based surgical and endoscopic procedures and tend to lead to worse patient outcomes, a new study reports.

The article in JAMA Surgery looked at those effects in a large, integrated healthcare delivery system where 10.6% of the patients reviewed were found to have experienced opioid-related adverse drug events (ORADEs).

Baylor Scott & White Health–led researchers used clinical and administrative data to identify 14,386 patients who had those results out of 135,379 undergoing surgical or endoscopic procedures where the painkillers are used. The consequences were significant, they note, including increased inpatient mortality, greater likelihood of discharge to another care facility, prolonged length of stay, high cost of hospitalization, and higher rate of 30-day readmission.

Study authors point out that although the focus of efforts to control overuse and misuse of painkillers tends to be on the outpatient setting, repercussions also can be serious in hospitals.

“Although these drugs are extremely effective analgesics, adverse effects are common and can be life threatening,” they write. “Opioid-related adverse drug events (ORADEs) exhibit a full spectrum of severity, ranging from mild pruritus/dermatitis to acute respiratory failure requiring mechanical ventilation. The incidence of ORADEs among surgical patients has ranged from 1.8% to 13.6%, and patients with ORADEs experience higher rates of inpatient mortality and 30-day readmission as well as prolonged length of stay and high cost of hospitalization.

Researchers conducted a retrospective study of clinical and administrative data to identify ORADEs using the International Classification of Diseases, Ninth Revision diagnosis codes for known adverse effects of opioids or opioid-antagonist use. The focus was on adult patients undergoing surgical or endoscopic procedures at 21 acute-care hospitals in a large integrated healthcare delivery system from January 1, 2013, to September 30, 2015.

Results indicate that patients with ORADEs were more likely to be older white males with more comorbidities. Researchers point out that patients with ORADEs also received a higher total dose of opioids (median morphine milligram equivalent dose, 46.8 vs. 30.0 mg; P < .001) and for a longer duration (median, 3.0 vs. 2.0 days; P <.001).
In adjusted analyses, ORADEs were associated with:
• Increased inpatient mortality (odds ratio [OR], 28.8; 95% CI, 24.0-34.5),
• Greater likelihood of discharge to another care facility (OR, 2.9; 95% CI, 2.7-3.0),
• Prolonged length of stay (OR, 3.1; 95% CI, 2.8-3.4),
• High cost of hospitalization (OR, 2.7; 95% CI, 2.4-3.0), and
• Higher rate of 30-day readmission (OR, 1.3; 95% CI, 1.2-1.4).

The adverse events also were linked to a 2.9% increase in absolute mortality, an $8,225 increased cost for the index hospitalization, and a 1.6-day increase in length of stay for the index hospitalization.

“Opioid-related adverse drug events were common among patients undergoing hospital-based invasive procedures and were associated with significantly worse clinical and cost outcomes,” study authors conclude. “Hospital-acquired harm from ORADEs in the surgical patient population is an important opportunity for health systems to improve patient safety and reduce cost.”

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