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The Impact of Opioid Utilization on Quality Outcomes and Costs in Laparoscopic Colorectal Surgery

Thais Reif De Paula, MD, Ravi P Kiran, MD, Deborah S Keller, MS, MD. Columbia University Medical Center

Background: The use of laparoscopy is proven to improve patient outcomes and costs. Prior work showed that laparoscopy had higher daily opioid use than open colorectal surgery, with lower overall use from the shorter length of stay (LOS). With the opioid epidemic and need to optimize improve outcomes and costs in the shift towards value-based care, investigation into the link between opioid utilization and outcome measures is warranted. Our goal was to evaluate the relationship between opioid utilization and quality outcomes of LOS, readmissions, complications and costs in elective laparoscopic colorectal surgery.

Methods: The Premier Database was reviewed for inpatient laparoscopic colorectal procedures where the patients received opioids during the postoperative course from 1/1/2014-9/30/2015. Opioid use was stratified into 4 groups based on the distribution of total Morphine Milligram Equivalents (MME/stay) in the population (<50, 50-110, 111-250, >250). Univariate analysis compared patient and provider demographics across the utilization groups. After controlling for patient and hospital characteristics, multivariate regression analyzed the relationship between opioid use, costs, and quality outcomes. 

Results: During the study period, 18,395 patients met inclusion criteria. The overall mean MME/stay was 62.27, and the mean days of opioid use was 3.61. For MME by group, 34% used <50 MME, 24% each used 50-110 and 111-250, and 18% used >250. In the univariate analysis, total opioid MME was directly associated with overall complications, LOS, readmissions, and total costs (all p<0.001) (Table 1). The multivariable analysis confirmed an independent effect of opioids on each of the quality outcome measures. Compared to low (<50MME/stay) opioid use, higher utilization was associated with a 57% longer LOS (OR 1.57, 95% CI 1.54-1.60, p<.0001), 63% higher overall complications (OR 1.63, 95% CI 1.47-1.82, p<.0001), 74% higher readmission rate (OR 1.74, 95% CI 1.48-2.05, p<.0001), and 28% higher total costs of care (OR 1.28, 95%CI 1.26-1.30, p<.0001).

Conclusions: There is a direct relationship between postoperative opioid dose and common quality outcome measures after elective laparoscopic colorectal surgery. Higher opioid doses were independently associated with higher complication and readmission rates, longer LOS, and higher costs. Furthermore, incremental increases in daily opioid use by MME was associated with corresponding increases in complications, readmissions, LOS, and costs. Given these results, greater emphasis should be placed on reducing opioid use to improves patient and financial outcomes after elective laparoscopic colorectal surgery. With the transition to value-based care, opioid use could become an addition quality measure


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 92274

Program Number: P330

Presentation Session: Poster Session (Non CME)

Presentation Type: Poster

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