Complications, Costs Up With Cardiac Sx in Opioid Use Disorder
No increased risk of mortality, but increase in incidence of major complications
WEDNESDAY, Dec. 26, 2018 (Pharmacist's Briefing) -- Patients with opioid use disorder (OUD) undergoing cardiac surgery have increased complications and costs, according to a study published online Dec. 5 in JAMA Surgery.
Krish C. Dewan, from the Cleveland Clinic Foundation, and colleagues compared outcomes between cardiac surgery patients with OUD (11,359 patients) and without OUD (5,707,193 patients) from 1998 to 2013.
The researchers found that over 15 years there was an eightfold increase in the prevalence of OUD, from 0.06 percent in 1998 to 0.54 percent in 2013. Patients with OUD more often had valve and aortic operations (49.8 versus 16.4 percent; P < 0.001). Mortality was similar for patients with and without OUD in propensity-matched pairs (3.1 versus 4.0 percent; P = 0.12), while the incidence of major complications was higher for patients with OUD (67.6 versus 59.2 percent; P < 0.001). Significantly higher risks of blood transfusion (30.4 versus 25.9 percent; P = 0.002), pulmonary embolism (7.3 versus 3.8 percent; P < 0.001), mechanical ventilation (18.4 versus 15.7 percent; P = 0.02), and prolonged postoperative pain (2.0 versus 1.2 percent; P = 0.048) were seen for patients with OUD. They also had a significantly longer length of stay (median, 11 versus 10 days; P < 0.001) and higher cost per patient ($49,790 versus $45,216; P < 0.001).
"In urgent situations, patients need not be denied cardiac surgery because of their OUD status, although close postoperative monitoring is suggested," the authors write.