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    Original Investigation
    August 2018

    Association of Opioid-Related Adverse Drug Events With Clinical and Cost Outcomes Among Surgical Patients in a Large Integrated Health Care Delivery System

    Author Affiliations
    • 1Center for Clinical Effectiveness, Baylor Scott & White Health, Dallas, Texas
    • 2Robbins Institute for Health Policy and Leadership, Baylor University, Waco, Texas
    • 3Center for Applied Health Research, Baylor Scott & White Health, Temple, Texas
    • 4Health Economics & Outcomes Research, Mallinckrodt Pharmaceuticals, Hampton, New Jersey
    • 5currently with the School of Pharmacy, University of California, San Francisco
    JAMA Surg. 2018;153(8):757-763. doi:10.1001/jamasurg.2018.1039
    Key Points

    Question  What are the incidence and consequences of opioid-related adverse drug events in patients undergoing hospital-based surgical and endoscopic procedures within a large, integrated health care delivery system?

    Findings  In this study of clinical and administrative data that included 135 379 patients, 14 386 (10.6%) experienced opioid-related adverse drug events. These events were associated with significantly worse patient outcomes, 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.

    Meaning  Opioid-related adverse drug events occur commonly during episodes for hospital-based surgical and endoscopic procedures and are associated with worse patient outcomes.


    Importance  Opioids are commonly used for pain control during and after invasive procedures. However, opioid-related adverse drug events (ORADEs) are common and have been associated with worse patient outcomes.

    Objectives  To examine the incidence of ORADEs in patients undergoing hospital-based surgical and endoscopic procedures and to evaluate the association of ORADEs with clinical and cost outcomes.

    Design, Setting, and Participants  In this retrospective study of clinical and administrative data, ORADEs were identified using International Classification of Diseases, Ninth Revision diagnosis codes for known adverse effects of opioids or by opioid antagonist use. Multivariable regression analysis was used to measure the association of ORADEs with outcomes after adjusting for potential confounding factors. The setting was 21 acute care hospitals in a large integrated health care delivery system. Participants were 135 379 patients (aged ≥18 years, admitted from January 1, 2013, to September 30, 2015) who underwent surgical and endoscopic procedures and were given opioids.

    Exposure  Opioid use, reported as morphine milligram equivalent doses.

    Main Outcomes and Measures  Opioid-related adverse drug events and their association with inpatient mortality, discharge to another care facility, length of stay, cost of hospitalization, and 30-day readmission.

    Results  Among 135 379 adult patients in this study (67.5% female), 14 386 (10.6%) experienced at least one ORADE. Patients with ORADEs were more likely to be older, of white race/ethnicity, and male and have more comorbidities. Patients with ORADEs 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). ORADEs were associated with a 2.9% increase in absolute mortality, an $8225 increase in cost for the index hospitalization, and a 1.6-day increase in length of stay for the index hospitalization.

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