Opioids Before Surgery Increase Medical Costs Afterwards, Worsen Patient Outcomes

There’s a heavy focus on prescription painkiller use following surgery. But a new study from the University of Michigan (U-M) highlighted the importance of looking at patients who are taking opioids before surgery.

People who were taking opioids before surgery were found to have longer hospital stays—resulting in higher costs for care. The researchers analyzed records from more than 200,000 middle-class Americans undergoing elective abdominal procedures.

“We often pause when we are considering elective surgery with a patient, based on known risk factors such as smoking, anticoagulant use, and overall medical conditions,” lead author, Jennifer Waljee, MD, MS, a plastic surgeon at Michigan Medicine, U-M’s academic medical center, said in a news release. “These findings suggest that perhaps preoperative opioid use warrants the same awareness.”

The procedures included hysterectomies, bariatric surgery, hernia repair, and reflux surgery within a 42-month span. All of the patients had spent at least 1 night in the hospital. About 9% of patients filled at least 2 opioid prescriptions within 90 days of surgery, at least one of which was filled within 60 days before surgery. The researchers observed a trend that these patients tended to have more medical and psychological conditions.

The findings indicated that within 30 days following surgery, those on opioids were more likely to either go to a rehabilitation facility or be readmitted to the hospital—4.5% of patients on opioids were readmitted to the hospital, compared to the 3.6% non-opioid users. This only wasn’t true for patients on the lowest-possible doses. The researchers recognized that this wasn’t a huge difference, but they did cause price increases.

During the first 90 days following surgery, the patients who had been on opioids leading up to their procedures had medical costs that were 3 times higher than those who did not take opioids. The difference between the groups grew smaller with time, but after 1 year, medical costs averaged at about $12,113 for non-opioid users and more than doubled at $25,000 for opioid users.

Beyond the costs, patients taking opioids leading up to surgery also had worse outcomes. They spent, on average, an extra half a day in the hospital after their procedures. This held true even after the team adjusted for other factors, like demographics and medical conditions.

Waljee suggested that physicians make a plan to manage a patient’s pain during the time leading up to surgery, while taking their opioid history into account.

“The bottom line is that preoperative opioid use is an important and potentially modifiable risk factor prior to surgery, and should be on surgeons’ radar as well as the minds of primary care providers,” Waljee continued.

Previous research by the team found that 21% of patients used prescription painkillers before surgery. In addition, those patients were more likely to have higher costs, complications, and readmissions.

“Coordinating care throughout the surgical period could improve clinical outcomes and the patient experience,” Waljee concluded.

The study, “Effect of Preoperative Opioid Exposure on Healthcare Utilization and Expenditures Following Elective Abdominal Surgery,” was published in the journal Annals of Surgery. The news release was provided by U-M.

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