(219) Discharging postoperative patients with an opioid prescription may result in greater reliance on opioid itself and increased healthcare expenditure and mortality
PhD candidate The University of Hong Kong, Hong Kong
Background: It remains unclear how opioid prescription at surgical discharge may affect patients’ continued opioid use and short-term outcomes.
Objectives: This study aimed to explore risk factors for persistent opioid use after surgical discharge and estimate the association between opioid prescription at discharge and postoperative healthcare utilization and mortality.
Methods: This population-based retrospective cohort study involved opioid-naïve patients who underwent surgical procedures from 1st January 2000, to November 30th 2020. The data source was Hong Kong Hospital Authority Clinical Management System electronic health record. The primary outcome was the incidence of new persistent opioid use. Other study outcomes included 30-day emergency department visits, 30-day readmission, and 30-day all-cause mortality. Multivariable logistic regression models were used to estimate the association between opioid prescription at discharge and persistent opioid use, emergency department visits, readmission, and all-cause mortality.
Results: Over a median follow-up of 1 month with 36,104 person-years, 438,128 patients (opioid prescription: 32,932, no opioid prescription: 405,196) who underwent surgical procedures were analysed, of whom 15,112 (3.45%) patients had persistent opioid use after discharge. Prescribing opioids on discharge was associated with increased risks of developing persistent opioid use (OR: 2.30, 95% CI: 2.19-2.40, p<0.001), 30-day emergency department visits (OR: 1.28, 95% CI: 1.23-1.33, p<0.001), 30-day readmission (OR: 1.17, 95% CI: 1.13-1.20, p<0.001), and 30-day all-cause mortality (OR: 1.68, 95% CI: 1.53-1.86, p<0.001).
Conclusions: In this large cohort of patients undergoing surgical operations, an opioid prescription on discharge was associated with a higher chance of persistent opioid use and increased risks of postoperative emergency department visits, readmission, and mortality. Minimizing opioid prescriptions on discharge may improve perioperative patient outcomes.
