Preoperative opioid, sedative, and antidepressant use is associated with increased postoperative hospital costs in color
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Preoperative opioid, sedative, and antidepressant use is associated with increased postoperative hospital costs in colorectal surgery Nicholas A. Jackson1 · Tong Gan1 · Daniel L. Davenport2 · Doug R. Oyler2,3 · Laura M. Ebbitt4 · B. Mark Evers2,3,5 · Avinash S. Bhakta2,3,6,7 Received: 28 July 2020 / Accepted: 29 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Opioid (OPD), sedative (SDT), and antidepressant (ADM) prescribing has increased dramatically over the last 20 years. This study evaluated preoperative OPD, SDT, and ADM use on hospital costs in patients undergoing colorectal resection at a single institution. Methods This study was a retrospective record review. The local ACS-NSQIP database was queried for adult patients (age ≥ 18 years) undergoing open/laparoscopic, partial/total colectomy, or proctectomy from January 1, 2013 to December 31, 2016. Individual patient medical records were reviewed to determine preoperative OPD, SDT, and AD use. Hospital cost data from index admission were captured by the hospital cost accounting system and matched to NSQIP query-identified cases. All ACS-NSQIP categorical patient characteristic, operative risk, and outcome variables were compared in medication groups using chi-square tests or Fisher’s exact tests, and continuous variables were compared using Mann–Whitney U tests. Results A total of 1185 colorectal procedures were performed by 30 different surgeons. Of these, 27.6% patients took OPD, 18.5% SDT, and 27.8% ADM preoperatively. Patients taking OPD, SDT, and ADM were found to have increased mean total hospital costs (MTHC) compared to non-users (30.8 vs 23.6 for OPD, 31.6 vs 24.4 for SDT, and 30.7 vs 23.8 for ADM). OPD and SDT use were identified as independent risk factors for increased MTHC on multivariable analysis. Conclusion Preoperative OPD and SDT use can be used to predict increased MTHC in patients undergoing colorectal resections. Keywords Opioids · Prescription drug use · Colorectal surgery · Healthcare costs · ACS-NSQIP
* Avinash S. Bhakta [email protected] 1
Graduate Medical Education, General Surgery Residency Program, University of Kentucky, Lexington, KY, USA
2
Department of Surgery, University of Kentucky, Lexington, KY, USA
3
Division of General Surgery, University of Kentucky, Lexington, KY, USA
4
Department of Pharmacy Services, University of Kentucky, Lexington, KY, USA
5
Markey Cancer Center, University of Kentucky, Lexington, KY, USA
6
Section of Colorectal Surgery, University of Kentucky, Lexington, KY, USA
7
University of Kentucky Medical Center, 800 Rose St., C‑233, Lexington, KY 40536, USA
Opioid, sedative, and antidepressant prescribing has increased dramatically over the last 20 years, and their use is now considered at the category of an epidemic. The use of opioids alone has seen an increase of 500% over that timeframe, and sedative medications have seen a nearly 50% increase, particularly in older patients [
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