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Cardiovascular Surgery in Patients with Opioid Use Disorder

Prevalence of OUD increased 8-fold over a 15-year span among this vulnerable population

A PPM Brief

With persistent opioid use a major concern among healthcare providers, a new study1 looked at the prevalence of Opioid Use Disorder (OUD) and its effect among patients undergoing cardiac surgery. A retrospective population-based cohort study included more than 5.7 million adult patients, excluding pregnant patients, who underwent cardiac surgery (ie, coronary artery bypass graft, valve surgery, or aortic surgery) in the US.

The study compared outcomes between cardiac surgery patients diagnosed with OUD (n = 11,359) and those without OUD (n = 5,707,193) using the Nationwide Inpatient Sample database, queried from January 1998 to December 2013. Among the total 5.7 million patients included, approximately 3.9 million (68.0%) were male. The mean age of patients with OUD was 47.67 years, while the mean age of patients without OUD was 65.53 years.

What are the associations of opioid use disorder with outcomes of cardiovascular surgery? (Source: 123RF)

The prevalence of OUD among cardiac surgery patients was 0.2% (n = 11,359), with an 8-fold increase over the 15-year span (0.06% in 1998 vs 0.54% in 2013; difference, 0.48%; 95% CI of difference, 0.45 - 0.51; P < 0.001). It was also found that valve and aortic operations were more commonly performed among patients with OUD (49.8% vs 16.4%; P < 0.001).

Compared to patients without OUD, cardiac surgery patients with OUD were on average younger (mean age, 48 years vs 66 years; P < 0.001) and more often male (70.8% vs 68.0%; P < 0.001), black (13.7% vs 4.8%), or Hispanic (9.1% vs 4.8%). Patients with OUD fell in the first quartile of median income (30.7% vs 17.1%; P < 0.001) and were more likely to be uninsured or to use Medicare (48.6% vs 7.7%; P < 0.001).

The mortality rate was similar between patients with OUD compared to those without OUD (3.1% vs 4.0%; P = 0.12), but cardiac surgery patients with OUD had an overall higher incidence of major complications (67.6% vs 59.2%; P < 0.001) such as risk of blood transfusion (30.4% vs 25.9%; P = 0.002), pulmonary embolism (7.3% vs 3.8%; P < 0.001), mechanical ventilation (18.4% vs 15.7%; P = 0.02), and prolonged post-operative pain (2.0% vs 1.2%; P = .0048). Patients with OUD also had a significantly longer length of hospital stay (median 11 vs 10 days; P < 0.001) and cost significantly more per patient (median $49,790 vs $45,216; P < 0.001).

“Preoperative OUD in cardiac surgery patients does not increase mortality but confers an increased burden of morbidity and resource utilization,” the authors concluded. “In urgent situations, patients need not be denied cardiac surgery because of their OUD status, although close post-operative monitoring is suggested.”

Last updated on: December 6, 2018
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