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PURPOSE: Laparoscopic colectomy results in decreased postoperative ileus, pain, and disability, and can therefore lead to a shorter length of hospital stay (LOS) and reduced costs of care. As opioids are often used in the treatment of postsurgical pain, this retrospective analysis, a subset of data from a large health economics and outcomes research project, examined the impact of opioid-related adverse events (ORAEs) on LOS and hospital costs for patients who underwent laparoscopic colectomy procedures.

METHODS: Over a 2-year period, 9/1/2008 through 9/30/2010, approximately 10 million annual hospital discharges were reviewed from a large national database including over 450 hospitals. Data on opioid usage, ORAEs, LOS, and hospital costs were reviewed for some of the most common surgeries in the US: open colectomy, laparoscopic colectomy, laparoscopic cholecystectomy, total abdominal hysterectomy and hip replacement, and populations were matched at a 3:1 ratio for age, gender, and APR severity of illness. Statistical analysis was performed on 181,283 matched hospital discharges after surgery, including 12,620 matched laparoscopic colectomies.

RESULTS: Of the 12,620 matched laparoscopic colectomies reviewed, mean unadjusted LOS for patients who had an ORAE was 7.7 days compared to 6.2 days for patients without an ORAE (P<0.0001). Similarly, unadjusted mean total costs for patients with an ORAE were significantly higher than for patients who did not have an ORAE (\,322 vs \,720, respectively; P<0.0001).

CONCLUSION: Patients who had a laparoscopic colectomy and experienced an ORAE had a longer LOS and higher total cost than similar patients who did not experience an ORAE. As the benefits of laparoscopic surgery include reduced LOS and cost, reducing the use of opioids and their consequent ORAEs would be expected to result in greater maintenance of those benefits.