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Director, Pharmacotherapy Outcomes Research Center; Professor, University of Utah Health Sciences Center, Salt Lake City, UT
Research Assistant Professor, Pharmacotherapy Outcomes Research Center, University of Utah Health Sciences Center
Senior Medical Informaticist, Department of Medical Informatics, LDS Hospital & Intermountain Health Care; Professor, Department of Medical Informatics, University of Utah School of Medicine, Salt Lake City, UT
Head, Section of Biostatistics, Division of Clinical Epidemiology, University of Utah School of Medicine
Senior Programmer/Analyst, Intermountain Health Care
Research Assistant Professor, Pharmacotherapy Outcomes Research Center, University of Utah Health Sciences Center
Director, US Outcomes Research, Pfizer, Inc., New York, NY
Chief, Division of Clinical Epidemiology; Professor of Medicine, University of Utah School of Medicine; Informatics; Decision Enhancement and Surveillance Center, Veterans Administration Salt Lake City Health Care System, Salt Lake City
Reprints: Dr. Oderda, Pharmacotherapy Outcomes Research Center, Department of Pharmacy Practice, 30 South 2000 East, Room 258, Salt Lake City, UT 84108, fax 801/585-6160, Gary.Oderda{at}pharm.utah.edu
BACKGROUND: Opioid analgesics remain a mainstay in the treatment of pain associated with surgical procedures. Such use is associated with adverse drug events (ADEs).
OBJECTIVE: To investigate the impact of opioid-related ADEs on total hospital costs and length of stay (LOS) in adult surgical patients.
METHODS: This was a retrospective matched cohort study using data from computerized medical records. ADE cases were prospectively detected using computerized surveillance and verified by pharmacists. Surgical patients treated at LDS Hospital in Salt Lake City from January 1, 1998, to December 31, 2003, were included. The primary outcomes were costs and hospital LOS associated with opioid-related ADEs and the relationship of opioid dose to ADE events.
RESULTS: Patients experiencing opioid-related ADEs had significantly increased median total hospital costs (7.4% increase; 95% CI 3.83 to 10.96; p < 0.001) and increased median LOS (10.3% increase; 95% CI 6.5 to 14.2; p < 0.001) compared with matched non-ADE controls. The increased costs attributable to ADEs, by surgery type, were general surgery ($676.51; 95% CI 351.50 to 1001.50), orthopedics ($861.50; 95% CI 448.20 to 1274.80), and obstetrics/gynecology ($540.90; 95% CI 281.40 to 800.40). Similarly, increased LOS attributable to ADEs, by surgery type, were general surgery (0.64 days; 95% CI 0.40 to 0.88), orthopedics (0.52 days; 95% CI 0.33 to 0.71), and obstetrics/gynecology (0.53 days; 95% CI 0.33 to 0.72). Higher doses of opioids were associated with increased risk of experiencing ADEs (OR 1.3; 95% CI 1.07 to 1.60; p = 0.01).
CONCLUSIONS: Opioid-related ADEs following surgery were associated with significantly increased LOS and hospitalization costs. These ADEs occurred more frequently in patients receiving higher doses of opioids.
Key Words: adverse events, opioids, pharmacoeconomics
Published Online, March 6, 2007. www.theannals.com, DOI 10.1345/aph.1H386
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