Opioid Analgesics: A Necessary Evil in the Post-Op Patient?

Prescription opioid analgesics play an important and legitimate role for surgical patients, and proper use by surgeons ensures that patients find the pain relief they need with few adverse events. A study in the September 2014 issue of the American Journal of Health-System Pharmacists suggests certain risk factors increase the likelihood of opioid-related adverse drug events (ORADEs) and subsequently increase costs, length of stay (LOS) and readmission rates.

This retrospective cohort study relied on data from 6,285 patients undergoing elective or emergency surgery who had been treated at a Texas health system that includes 11 hospitals. The study covered a one-year period. Almost all patients (n=6,274 or 99.8%) received postsurgical opioid analgesics.

Patients who were most likely to experience an ORADE tended to be older (≥65 years), male, obese and had used opioids in the past. Among comorbidities, 3 gastrointestinal conditions (regional enteritis, diverticulitis, and ulcerative colitis) were most often associated with ORADE. Other diseases that increased ORADE risk included chronic obstructive pulmonary disease, cardiovascular disease (arrhythmias, atherosclerosis, and hypertension) and diabetes. Benign prostatic hypertrophy, which was diagnosed in 42% of men, appeared to increase the rate of adverse drug reactions 5-fold.

Patients with no risk factors incurred smaller hospitalization costs ($11,433) than those with one risk factor ($14,110). Multiple risk factors increased hospitalization cost quite significantly and disproportionately to a mean of $21,073.

Among all patients, the 11.5% who experienced ORADEs were more likely to be cost- and LOS-outliers. LOS was 80% higher than that of ORADE-free patients, and costs were 86% higher.

The researchers suggest considering alternative approaches to manage postsurgical pain in high-risk patients. Opioid-sparing strategies like using lower opioid doses augmented with other analgesics is one approach. Another is replacing opioids with nonsteroidal anti-inflammatory drugs, acetaminophen, bupivacaine (and devices to extend its delivery), elastomeric pain pumps, and sustained release delivery technologies.