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Clin Neurol Neurosurg. 2019 Nov;186:105550. doi: 10.1016/j.clineuro.2019.105550. Epub 2019 Oct 3.

Potential opioid-related adverse events following spine surgery in elderly patients.

Author information

1
Department of Anesthesiology and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
2
Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA, United States.
3
Department of Anesthesiology, Medical College of Wisconsin, Wausau, WI, United States.
4
Dexur Research & Analytics, New York City, NY, United States.
5
Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, United States; Center for Perioperative Research, Brigham and Women's Hospital, Boston, MA, United States. Electronic address: rurman@bwh.harvard.edu.

Abstract

OBJECTIVE:

Understanding the clinical and economic impact of opioid-related adverse drug events (ORADEs) within spine surgery may guide both the clinician's and hospital administration's approach to treating perioperative pain, thus improving patient care and reducing hospital costs. The objective of this analysis is to understand how potential ORADEs after spine surgery in elderly patients affect length of stay, hospital revenue and their association with comorbid conditions.

PATIENTS AND METHODS:

We conducted a retrospective study utilizing the Center for Medicare/Medicaid Services Administrative Database to analyze Medicare discharges between April 2016 and March 2017 involving 14 spine surgery DRGs for major spine procedures in order to identify potential ORADEs. An analysis was conducted using this database to identify the incidence of potential ORADEs as well as their impact on mean hospital length of stay and hospital revenue.

RESULTS:

There were 177,432 discharges during the study period. The ORADE rate in patients undergoing spine surgery was 13.9% (24,642/177,432). The mean length of stay (LOS) for discharges with an ORADE was 3.13 days longer than without an ORADE (6.29 days with an ORADE vs 3.16 days without an ORADE). The adverse post-operative outcomes most strongly associated with potential ORADEs included shock, pneumonia, and septicemia. The mean hospital revenue per day with an ORADE was $3,076 less than without an ORADE ($7,263 with an ORADE vs $10,339 without an ORADE).

CONCLUSION:

Potential ORADEs in spine surgery in elderly patients are common and are associated with longer hospitalizations and decreased hospital revenue. Perioperative pain management strategies that reduce ORADEs may improve patient care and increase hospital revenue.

KEYWORDS:

Adverse event; Complications; Cost; Length of stay; Opioids; Spine surgery

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