Impact of Opioid Related Adverse Events on Cardiac Surgery Service Line
Keith B. Allen1, Nikhileah Rao2, Christopher Lipp1, David J. Cohen1, Suzanne J. Baron1, Sanjeev Aggarwal1, J. Russell Davis1, Eric Thompson1, Karthik Vamanan1, Jessica Heimes1, Alex F. Pak1, A. Michael Borkon1
1Saint Luke's Mid America Heart Institute, Kansas City, MO;2Dexur Analytics, New York, NY
OBJECTIVES: The use of opioids in postoperative pain management regimens following cardiac surgery can be associated with opioid related adverse drug events (ORADEs) including respiratory depression, confusion, ileus, urinary retention, constipation, pruritus and atelectasis. A better understanding of the incidence and economic impact of ORADEs may expedite changes to postoperative pain management that could improve patient outcomes while at the same time reducing costly complications for the hospital.
METHODS: We performed a retrospective study using the Center for Medicare/Medicaid Services (CMS) administrative claims database to identify potential ORADEs and their impact on resource utilization among patients undergoing coronary bypass and cardiac valve surgery. Between April 2016 and March 2017, we identified 107,169 Medicare discharges who underwent cardiac valve (n=49,139; DRG 216-221) or coronary bypass (n=58,031; DRG 233-236) surgery. The rate of potential ORADEs was based on ICD-9/10 codes. Hospital resource consumption in patients with and without an ORADE, including impact on LOS and hospital daily Medicare revenue, were analyzed.
RESULTS:Table 1 summarizes the findings for each DRG. Among the 10-cardiac valve and coronary DRG's analyzed, potential ORADEs occurred in 32.2% (34,469/107,169) of patients (range 7-54%). Overall mean hospital LOS was approximately 3 days longer in patients with versus without a potential ORADE [11.2 days (range 7.0-16.2) vs 8.2 days (range 4.8-12.9); p<0.05]. When separated out by individual DRGs, average overall hospital LOS was always significantly longer in patients with versus without an ORADE (Table 1). Owing to the longer LOS, mean hospital Medicare revenue per day over the entire spectrum of DRGs analyzed was less in patients with an ORADE compared to those without an ORADE [$4,042 (range $3,238-5,492) vs $4,432 (range $3,466-6,329); p<0.05). The average net difference in revenue per day between patients with and without an ORADE was $389 (range $228-937). The reduction in revenue per day for patients with and without an ORADE was larger in valve DRGs (range $472-937) compared to coronary bypass DRGs (range $228-394).
CONCLUSIONS: Potential ORADEs occur frequently following cardiac valve and coronary bypass procedures and are associated with increased length of stay and reduced daily revenue. Adopting postoperative pain management strategies that reduce ORADEs may improve patient outcomes while at the same time reducing LOS and increasing service line daily revenue.
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