Massachusetts Chapter of the American College of Surgeons

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Evaluating the Contemporary Impact of the Opioid Addiction on Cardiac Surgery Outcomes: An Analysis of 1.7 Million Surgeries
Sameer Hirji, Rohan M. Shah, Farhang Yazdchi, Siobhan McGurk, Marc P. Pelletier, Prem Shekar, Tsuyoshi Kaneko
Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA

Background: Despite the ongoing opioid epidemic, clinical impact of the opioid addiction on cardiac surgery outcomes is not well described. We evaluated the impact of opioid use on in-hospital outcomes among opioid addicted patients after cardiac surgery.

Methods: Using the National Inpatient Sample, we isolated patients undergoing coronary artery bypass grafting, valve repair or valve replacement from 2009-2014. Patients were stratified by opioid use using ICD-9 codes. Multivariable analysis was performed to evaluate the association between opioid use and in-hospital outcomes.

Results: 1,743,161 patients underwent cardiac surgery, including 6,960 patients who suffered from opioid abuse or dependence (0.4%). Although in-hospital mortality did not differ among opioid and non-opioid users (2.9% and 2.7%), opioid users had significantly longer hospital LOS (18 vs 10 days) and higher hospitalization costs ($81,238 vs $58,654; all p < 0.05). After adjusting for patient and hospital-level factors, opioid use was significantly associated with complete heart block (OR 1.9, 95% CI: 1.3-2.6), stroke (OR 1.71, 95% CI: 1.2-2.4), acute kidney injury (OR 1.3, 95% CI: 1.1-1.6), and longer hospital LOS (3.5 days, 95% CI: 2.4-4.6; all p<0.01) compared to non-opioid users. (Figure 1)

Conclusions: Cardiac surgery patients who suffer from opioid addiction (either abuse or dependence) are high-risk for developing post-operative complications. Strategies to minimize post-operative complications are warranted to improve overall morbidity and mortality in these vulnerable populations in the context to the current opioid epidemic.

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USS Constitution
Paul Revere