Opioid Use Linked to Higher Costs and Longer Hospital Stays

Opioid-related adverse events are associated with significant cost increases and longer hospital stays in patients who received the medications for postsurgical pain management, according to data presented at the 2011 Midyear Clinical Meeting of the American Society of Health-Systems Pharmacists (ASHP) in New Orleans.

New data gleaned from a national database of patients demonstrated that opioid-related adverse events (ORAEs) are associated with more than a $1000 increase in hospitalization cost and more than a day increase in length of hospital stay (LOS). The study included patients from 381 US hospitals who underwent common hospital-based surgical procedures and received opioids for postsurgical pain management.

The findings were presented Monday during a poster session at the 2011 Midyear Clinical Meeting of the American Society of Health-Systems Pharmacists (ASHP) in New Orleans.

In this retrospective analysis, researchers utilized Premier’s database to identify adult patients who underwent common soft tissue and orthopedic surgical procedures and received opioids from September 2008 to August 2010. All opioids consumed were converted to morphine-equivalent doses. Approximately 20% of surgical patients were identified as experiencing an ORAE.

A comparison of the mean total hospitalization cost and LOS revealed that patients experiencing an ORAE had a 1.1-day increase in mean LOS compared and a $1028 mean increase from the baseline hospitalization cost compared to patients who did not.

“Opioids have long been associated with a range of unwanted side effects in postsurgical patients, from nausea, vomiting and constipation to urinary retention, pruritus and respiratory depression, some of which, such as respiratory depression, can be severe and life threatening,” said Gary Oderda, PharmD, MPH, of University of Utah College of Pharmacy. “In addition to the negative impact these events have on patients’ recovery, these data indicate they place a significant economic burden on hospitals and health care systems, as well.”

Dr. Oderda conducted the research in conjunction with TJ Gan, MD, MHS, of Duke University Medical Center, and in collaboration with Premier Research Services, part of the Premier Healthcare Alliance. The research was supported by Pacira Pharmaceuticals Inc.

“These data not only demonstrate the strong correlation between total opioid consumption, opioid-related adverse events and cost, but also highlight the value of a multimodal, opioid-sparing approach to postsurgical pain management,” said Dr. Gan. “By utilizing a combination of therapeutics, surgeons can provide effective analgesia while limiting the adverse events associated with opioids, which could provide significant benefits to both patients and hospital economics.”

Another study presented during the poster session identified patients undergoing total abdominal hysterectomy (TAH) in one of Barnabas Health’s 6 hospitals from January 2007 to December 2010 to identify any relationship between opioid use and increased LOS and overall cost in patients undergoing TAH.

The 97 TAH patients with the longest LOS, termed “outliers,” were matched to a control group of TAH surgical patients in the database. Medical records from both groups were reviewed for total opioid use, incidence of ORAEs and total cost of hospitalization.

Researchers determined that total opioid consumption in the outlier group was more than double that of the control group (150 mg vs 74 mg); additional findings include:

• Respiratory ORAEs occurred 12 times more often in patients in the outlier group than in the control group (12% vs 1%); gastrointestinal ORAEs occurred more than twice as often (44% vs 19%)
• Total hospitalization cost was more than $8500 higher in the outlier group compared to the control group ($14,275 vs $5745)

“We are pleased to see large health systems and major health care alliances such as Premier and Barnabas Health provide health outcomes and financial analysis to continue to quantify and address the costs of opioid use in postsurgical care in U.S. hospitals,” said Dave Stack, president and CEO of Pacira Pharmaceuticals, which supported the research. “As hospitals continue to strive for economic efficiency and increased patient satisfaction, these data provide insight into areas where the current standard of care may benefit from a critical review and further investigation regarding economic impact.”