OSTOPERATIVE PAIN AFFECTS A variety of physiological functions and can adversely influence surgical outcome. 1 Efficient management of acute postoperative pain has been demonstrated to improve clinical outcome 2 and effective postoperative analgesia is part of a major initiative for US hospitals, with the introduction of pain as the fifth monitored vital sign. 3 Surgical trauma induces cyclooxygenase 2 (COX-2) and subsequent synthesis of prostaglandins that sensitize peripheral nociceptors and mediate central sensitization. 4 In addition to analgesic synergism with opioids, 5 nonsteroidal anti-inflammatory drugs (NSAIDs) decrease this inflammatory response associated with surgery. 6 There is evidence that prostaglandin synthesis plays a role in postoperative orthopedic pain. 7 Inadequate control of postoperative pain has been associated with poor functional recovery after total knee arthroplasty (TKA). 8 Preoperative administration of NSAIDs may be effective by establishing a sufficient tissue NSAID concentration to Author Affiliations are listed at the end of this article.

Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.

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