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Intraoperative Opioid Doses and Rates of Hospital Readmission

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The use of high doses of opioids — particularly long-acting opioids — during surgery may increase the risk for 30-day readmission, according to a recent study published in British Journal of Anaesthesia.

The registry data of 153,902 patients (ambulatory surgery, n=40,060; non-ambulatory surgery, n=113,842) who underwent surgery with general anesthesia at 3 hospitals, including Massachusetts General Hospital, between January 2007 and December 2015 were analyzed. Intraoperative opioid doses were categorized in 5 quintiles, ranging from median (average, 8 morphine milligram equivalents [MME]) to high (average, 32 MME).

Intraoperative use of high (27-41 MME) vs lower doses of opioids was found to be associated with increased odds of 30-day hospital readmission (odds ratio, 1.15; 95% CI, 1.07-1.24; P <.001). For ambulatory surgeries, the odds of 30-day readmission were also increased for intraoperative opioid doses of 11 MME to 15 MME (P =.001) and 15 MME to 27 MME (P <.001) compared with doses of 0 MME to 12 MME. Predicted (adjusted) 30-day readmission rates in all patients ranged from 7.5% for the lower doses of intraoperative opioids to 8.5% for the higher doses examined.

Postoperative respiratory complications, which occurred within 7 days of surgery in 8.5% of patients, were found to be associated with 30-day readmission (P <.001). No association was established between high doses of intraoperative opioids and increased risk for postoperative respiratory complications. Odds of 30-day readmission were found to be higher for long- vs short-acting opioids after both ambulatory and non-ambulatory surgery. In addition, use of high doses of opioids during outpatient surgery was found to increase the risk for early readmission (ie, 0-2 days vs 3-30 days after surgery; P <.001).

Researchers noted that their study was limited by its retrospective nature, as well as by the use of billing, prescription, and other administrative data sets that, in some cases, included missing values.

“Our data support the view that conservative intraoperative opioid-dosing standards, particularly in outpatient surgery, may yield improved postoperative outcomes and lend credence to efforts aimed at developing opioid-sparing anesthetic protocols,” concluded the study authors.

Reference

Long DR, Lihn AL, Friedrich S, et al. Association between intraoperative opioid administration and 30-day readmission: A pre-specified analysis of registry data from a healthcare network in New England published online January 25, 2018. Br J Anaesth. 2018;120(5):1090-1102.

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