Impact of preexisting opioid dependence on morbidity, length of stay, and inpatient cost of urological oncological surgery

Authors

Sohrab Arora, Henry Ford HealthFollow
Chandler Bronkema, Henry Ford HealthFollow
Sami E. Majdalani, Henry Ford HealthFollow
Nicholas Corsi, Henry Ford HealthFollow
Ivan Rakic, Henry Ford HealthFollow
Austin J. Piontkowski, Henry Ford HealthFollow
Akshay Sood, Henry Ford HealthFollow
Matthew Davis, Henry Ford HealthFollow
Daniele Modonutti, Henry Ford Health
Giacomo Novara
Craig G. Rogers, Henry Ford HealthFollow
Firas Abdollah, Henry Ford HealthFollow

Recommended Citation

Arora S, Bronkema C, Majdalany SE, Corsi N, Rakic I, Piontkowski A, Sood A, Davis MJ, Modonutti D, Novara G, Rogers CG, and Abdollah F. Impact of preexisting opioid dependence on morbidity, length of stay, and inpatient cost of urological oncological surgery. World J Urol 2023.

Document Type

Article

Publication Date

2-8-2023

Publication Title

World journal of urology

Abstract

OBJECTIVES: To determine the incidence of preexisting opioid dependence in patients undergoing elective urological oncological surgery. In addition, to quantify the impact of preexisting opioid dependence on outcomes and cost of common urologic oncological procedures at a national level in the USA.

METHODS: We used the National Inpatient Sample (NIS) to study 1,609,948 admissions for elective partial/radical nephrectomy, radical prostatectomy, and cystectomy procedures. Trends of preexisting opioid dependence were studied over 2003-2014. We use multivariable-adjusted analysis to compare opioid-dependent patients to those without opioid dependence (reference group) in terms of outcomes, namely major complications, length of stay (LOS), and total cost.

RESULTS: The incidence of opioid dependence steadily increased from 0.6 per 1000 patients in 2003 to 2 per 1000 in 2014. Opioid-dependent patients had a significantly higher rate of major complications (18 vs 10%; p < 0.001) and longer LOS (4 days (IQR 2-7) vs 2 days (IQR 1-4); p < 0.001), when compared to the non-opioid-dependent counterparts. Opioid dependence also increased the overall cost by 48% (adjusted median cost $18,290 [IQR 12,549-27,715] vs. $12,383 [IQR 9225-17,494] in non-opioid-dependent, p < 0.001). Multivariable analysis confirmed the independent association of preexisting opioid dependence with major complications, length of stay in 4th quartile, and total cost in 4th quartile.

CONCLUSIONS: The incidence of preexisting opioid dependence before elective urological oncology is increasing and is associated with adverse outcomes after surgery. There is a need to further understand the challenges associated with opioid dependence before surgery and identify and optimize these patients to improve outcomes.

PubMed ID

36754878

ePublication

ePub ahead of print