Laparoscopic Colectomy and Opioid-Related Adverse Events

San Diego—A retrospective post hoc database analysis found that patients who underwent laparoscopic colectomy and had an opioid-related adverse event spent more time in the hospital and had a higher total cost compared with those who had no opioid-related adverse event after the procedure.

Results were presented in a poster session during DDW. The poster was titled Impact of Opioid Related Adverse Events on Length of Stay and Hospital Costs in Patients Undergoing a Laparoscopic Colectomy.

Each year in the United States, there are approximately 70 million surgeries, and 70% of the patients experience pain after undergoing surgery. To lessen the pain, patients are typically prescribed opioid medications, however, these medications can lead to complications. The authors said laparoscopic colectomy has been associated with decreased ileus, pain, and disability after surgery.

In this study, the authors examined the Premier Perspective^® database of all inpatients and hospital-based outpatients in a diverse cohort of >475 hospitals that serve approximately 85 million patients. They examined approximately 10 million hospital discharges and identified patients who were ≥18 years of age, underwent laparoscopic colectomy, took opioids after surgery, and were discharged from the hospital from September 1, 2008, to September 30, 2008.

In the analysis, 21.2% of patients experienced an opioid-related adverse event. The authors matched patients at a 3:1 ratio for age, sex, and severity of illness. They performed a statistical analysis on 181,283 matched hospital discharges after surgery and reviewed 12,620 matched laparoscopic colectomies.

In the matched cohort, the mean length of stay in the hospital was 7.7 days in patients who had an opioid-related adverse event compared with 6.2 days for those who did not have an opioid-related adverse event (P<.0001). The unmatched mean length of stay was 9.7 days in patients who had an opioid-related adverse event compared with 5.4 days in those who did not have an opioid-related adverse event (P<.0001).

The mean total cost in the matched cohort was $18,322 for patients experiencing an opioid-related adverse event and $15,720 for those who did not have an opioid-related adverse event (P<.0001). In the unmatched group, the mean total cost was $23,776 in those who had an opioid-related adverse event and $14,189 if they had no opioid-related adverse event (P<.0001).

In conclusion, the researchers said, “Patients who had a laparoscopic colectomy and experienced an opioid-related adverse event had a longer length of stay and higher total cost than similar patients who did not experience an opioid-related adverse event. Moreover, more outliers were identified in the opioid-related adverse event group attenuating the known benefits of shorter hospital stay and reduced costs associated with laparoscopic procedures. This study underscores the need to reduce the use of opioids for pain control.”

Limitations to the study cited by the researchers included using an observational database, which can lead to selection bias and reliance on accurate and complete International Classification of Diseases, Ninth Revision coding and billing.

This study was supported by Pacira Pharmaceuticals, Inc.