PRESCRIPTION OPIOID USE INCREASES RESOURCE UTILIZATION FOLLOWING VENTRAL HERNIA REPAIR
Skyler Palmer*, Margaret A. Plymale, Anthony A. Mangino, Daniel L. Davenport, John S. Roth
College of Medicine, University of Kentucky, Lexington, KY
Introduction
We and others have shown that preoperative opioid use is associated with increased postoperative opioid use and surgical site infection in patients undergoing ventral hernia repair. The orthopaedic surgery literature cites increased resource utilization with opioid use. The purpose of this study is to determine the impact of preoperative opioid use upon resource utilization following open ventral hernia repair.
Methods
A retrospective IRB approved study of ventral hernia repairs from a single tertiary care practice between 2013 and 2020 was performed. Medical records, National Surgery Quality Improvement Program (NSQIP) database, and Kentucky All Scheduled Prescription Electronic Reporting (KASPER) data were reviewed for patient demographics, comorbidities, dispensed opiate prescriptions, hernia characteristics, and outcomes. Univariate logistic regression analyses were employed to assess the impact of each patient demographic and clinical characteristic. Multivariate logistic regression models were analyzed using significant factors from the univariate analyses. Primary outcomes were resource utilization variables including readmissions, emergency department (ED) visits, and >2 postoperative clinic visits within 45 days of operation.
Results
381 ventral hernia repair patients were identified, of which 101 had preoperative dispensed opioids. Patient sex, obesity status, dyspnea, and COPD history were predictive of one or more outcomes (Table). As expected, surgical site infection (SSI) was associated with increased rates of readmission (14.3, P<0.001), ED visits (5.82, P<0.001), and >2 clinic visits (5.96, P<0.001). Preoperative opioid use was associated with increased readmissions (1.93, P<0.05) and ED visits (2.19, P<0.05), particularly ED visits for pain (3.31, P<0.05), and remained so after multivariable adjustment.
Conclusion
Preoperative opioid use is a risk factor for post-discharge ED visits and readmission. An understanding of drivers of increased utilization of resources is essential in developing strategies to improve healthcare value. Future research will focus upon strategies to reduce utilization of resources among patients who use opioids.
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