Mariano E. Menendez|David Ring|Brian T. Bateman
Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery
Massachusetts General Hospital|Massachusetts General Hospital|Brigham and Women's Hospital|Harvard University|Massachusetts General Hospital
many patients discretionary orthopaedic surgery take opioids daily either prescription illicitly however little known regarding prevalence effect highrisk opioid use eg abuse dependence perioperative orthopaedic settingwe sought 1 determine prevalence opioid abuse dependence patients undergoing major elective orthopaedic surgery 2 characterize relationship opioid abuse dependence inhospital postoperative mortality adverse events failure rescue prolonged length stay nonroutine disposition 3 identify factors associated highrisk opioid usewe used coding data collected discharge records nationwide inpatient sample 20022011 analyzed changes time prevalence opioid abuse dependence admission finally used multivariate regression modeling measure association opioid abuse dependence inhospital postoperative mortality morbidity resource utilization identify factors associated highrisk opioid usethe prevalence opioid abuse dependence increased 0095 2002 024 2011 increase 152 p 0001 opioid abuse dependence associated increased inpatient mortality odds ratio 37 95 ci 2751 aggregate morbidity 23 l 95 ci 2224 including induced mental disorder 59 95 ci 5463 respiratory failure 31 95 ci 2736 surgical site infection 25 95 ci 2030 mechanical ventilation 23 95 ci 2025 pneumonia 21 95 ci 1823 myocardial infarction 19 95 ci 1326 postoperative ileus gastrointestinal events 14 95 ci 1316 p 0001 listed entities abuse dependence also associated increased risk prolonged hospital length stay 25 95 ci 2425 nonroutine discharge 22 95 ci 2223 failure rescue 20 95 ci 1428 highrisk opioid users likely younger male nonwhite medicaidinsured patients mental health substance use disorders undergoing spine surgery hospitalrelated characteristics included urban setting geographic location northeast west serving teaching facilityopioid abuse dependence increasing rapidly among orthopaedic surgical inpatients associated considerable postoperative morbidity mortality resource utilization recommend orthopaedic surgeons screen patients carefully opioid misuse preoperatively help patients using opioids inappropriately discontinue scheduling elective surgery decline perform elective surgery patients misuse opioids closely monitor patients habituated opioids time undergo surgerylevel iii prognostic study