Cost and Quality Implications of Opioid‐Based Postsurgical Pain Control Using Administrative Claims Data from a Large Health System: Opioid‐Related Adverse Events and Their Impact on Clinical and Economic Outcomes

Kessler, Ellen; Shah, Manan; Gruschkus, Stephen K.; Raju, Aditya

doi:10.1002/phar.1223

Cited by 269 publications

(280 citation statements)

References 38 publications

(82 reference statements)

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“…14,15,[17][18][19][20] The frequency of postoperative ORADEs also poses a significant economic burden and strain on resources to hospitals and health care providers. For example, respiratory depression and nausea/vomiting require increased monitoring by the nursing staff and increased utilization of supportive care therapies such as antiemetics.…”

Section: Study Design and Sample Selectionmentioning

confidence: 99%

“…11 Previously demonstrated patient-specific ADE risk factors include older age, male gender, race/ethnicity, smoking status, obesity, and comorbid diagnoses such as obstructive sleep apnea (OSA), chronic obstructive pulmonary disease (COPD), renal and hepatic function, cardiac dysrhythmia, degenerative joint disease (DJD), and benign prostatic hyperplasia (BPH). 6,[12][13][14][15] Medication error, which is common with opioid delivery systems, also contributes substantially to the risk of developing an ORADE. 16 • Opioid-related adverse drug events (ORADEs) are common causes of hospitalizations and increased health care costs.…”

mentioning

confidence: 99%

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Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

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BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility of a risk-scoring model in categorizing patients at high risk of experiencing ORADEs; and (c) quantify potential clinical/economic benefits of targeting high-risk GI surgical patients for opioid-sparing regimens in terms of hospitalization cost, length of stay (LOS), and 30-day readmission rates. METHODS: Using a retrospective design based on an administrative database, patients with an inpatient surgical procedure between January 1, 2010, and December 31, 2010, were included. GI surgical patients aged > 18 years followed from admission through 30 days postdischarge were characterized as high or low risk using clinical/demographic characteristics and were evaluated for several outcomes. Using multivariate logistic regression, the ORADE incidence, total hospitalization cost, LOS, and 30-day readmissions were compared for high-risk and low-risk patients. RESULTS: In 87.8% (n = 3,235) of the surgical population, there was a strong concordance between risk assignment and ORADE incidence. Among the remaining 12.2% (n = 449) of patients, 5.5% (n = 202) were low risk with an ORADE, and 6.7% (n = 247) were high risk without an ORADE. Overall, 20.6% (n = 344) of high-risk patients experienced ≥ 1 ORADE (mean cost: $31,988; LOS: 12.1 days) compared with only 5.3% (n = 107) of lowrisk patients (mean cost: $25,216; LOS: 8.0 days). High-risk patients had higher hospitalization costs and longer LOS than low-risk patients, respectively (mean cost: $19,234 vs. $13,036; mean LOS: 6.8 days vs. 3.3 days). These differences correspond to 47.0% higher costs for high-risk patients and an LOS approximately twice as long compared with low-risk patients. CONCLUSIONS: Patient clinical/demographic characteristics influence the risk of developing ORADEs. Risk assessment tools can effectively identify high-risk patients, thereby enabling interventions that can reduce ORADEs, decrease hospital costs, and improve postsurgical experiences for patients.

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Section: Study Design and Sample Selectionmentioning

confidence: 99%

mentioning

confidence: 99%

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Minkowitz¹,

Scranton

Gruschkus

et al. 2014

JMCP

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“…Despite its success improving the quality of life of patients with arthritis [31], pain after TKA can sometimes be severe and difficult to control [1]. Clinical studies have shown that severe postoperative pain can be associated with an increased risk of complications, including rehabilitation delay [59], prolonged return to normal functioning [27,28], progression to persistent pain states [46,68], prolonged hospital stay [49], and increased readmission rate [21], all of which can lead to increased cost of care [4,42,62,69].…”

Section: Introductionmentioning

confidence: 99%

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

Barrington

Emerson

Lovald

et al. 2017

Clinical Orthopaedics &Amp; Related Research

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Background Opioid analgesics have been a standard modality for postoperative pain management after total knee arthroplasty (TKA) but are also associated with increased risk of nausea, pruritus, vomiting, respiratory depression, prolonged ileus, and cognitive dysfunction.There is still a need for a method of anesthesia that can deliver effective long-term postoperative pain relief without incurring the high cost and health burden of opioids and nerve blocks. Questions/purposes (1) Is liposomal bupivacaine-based periarticular injection (PAI) more effective than morphinebased spinal anesthesia or ropivacaine-based PAI in

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“…Understanding the mechanisms underlying this variability can help identify susceptible patient populations. Opioid-related adverse events occur in approximately 15% of postoperative patients in the clinical setting (Kessler et al, 2013) and represent a subset of VDRs that may be attenuated by considering altered function of opioid metabolizing enzymes and transporters (Fujita et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Mechanistic Basis of Altered Morphine Disposition in Nonalcoholic Steatohepatitis

Dzierlenga

Clarke

Hargraves

et al. 2014

J Pharmacol Exp Ther

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Morphine is metabolized in humans to morphine-3-glucuronide (M3G) and the pharmacologically active morphine-6-glucuronide (M6G). The hepatobiliary disposition of both metabolites relies upon multidrug resistance-associated proteins Mrp3 and Mrp2, located on the sinusoidal and canalicular membrane, respectively. Nonalcoholic steatohepatitis (NASH), the severe stage of nonalcoholic fatty liver disease, alters xenobiotic metabolizing enzyme and transporter function. The purpose of this study was to determine whether NASH contributes to the large interindividual variability and postoperative adverse events associated with morphine therapy. Male Sprague-Dawley rats were fed a control diet or a methionine-and choline-deficient diet to induce NASH. Radiolabeled morphine (2.5 mg/kg, 30 mCi/kg) was administered intravenously, and plasma and bile (0-150 or 0-240 minutes), liver and kidney, and cumulative urine were analyzed for morphine and M3G. The antinociceptive response to M6G (5 mg/kg) was assessed (0-12 hours) after direct intraperitoneal administration since rats do not produce M6G. NASH caused a net decrease in morphine concentrations in the bile and plasma and a net increase in the M3G/morphine plasma area under the concentration-time curve ratio, consistent with upregulation of UDP-glucuronosyltransferase Ugt2b1. Despite increased systemic exposure to M3G, NASH resulted in decreased biliary excretion and hepatic accumulation of M3G. This shift toward systemic retention is consistent with the mislocalization of canalicular Mrp2 and increased expression of sinusoidal Mrp3 in NASH and may correlate to increased antinociception by M6G. Increased metabolism and altered transporter regulation in NASH provide a mechanistic basis for interindividual variability in morphine disposition that may lead to opioid-related toxicity.

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Cost and Quality Implications of Opioid‐Based Postsurgical Pain Control Using Administrative Claims Data from a Large Health System: Opioid‐Related Adverse Events and Their Impact on Clinical and Economic Outcomes

Cited by 269 publications

References 38 publications

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

No Difference in Early Analgesia Between Liposomal Bupivacaine Injection and Intrathecal Morphine After TKA

Mechanistic Basis of Altered Morphine Disposition in Nonalcoholic Steatohepatitis

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