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Quality

Quality & Disparities Parallel Session

78: Health Outcomes among Patients with New Persistent Opioid Use Following Gastrointestinal Cancer Surgery

Saturday, March 23, 2024
8:42am – 8:52am ET
Location: C102
Disclosure(s):
Mujtaba Khalil, MD: No financial relationships to disclose
Introduction: Over the last decade, nearly 650,000 people have died from an overdose involving an opioid. In light of the opioid epidemic, the development of new persistent opioid use (NPOU) after surgery has been identified as a public health concern. We sought to define long-term health outcomes among patients who developed NPOU following gastrointestinal (GI) cancer surgery.


Methods: Patients who underwent surgery for gastric, hepatopancreatobiliary, and colorectal cancer from 2007-2016 were identified using the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database. NPOU was defined as filling an opioid prescription both in the first 90 days, as well as again within 90-180 days after surgery among opioid-naïve patients. Mixed-effect multivariable logistic regression and cox proportional hazard models were used to estimate the risk of mortality and emergency department visits due to falls, respiratory, and opioid-related conditions.


Results: Among 20,603 patients undergoing GI cancer surgery, 1,351 (6.6%) developed NPOU. Patients who developed NPOU were younger (72 years [IQR: 69 – 77] vs. 75 years  [IQR: 70 – 80]), had a higher Charlson Comorbidity Index score (CCI >2; 61.6% vs. 48.8%), and were more likely to reside in non-metropolitan areas (14.4% vs. 12.4%) (all p< 0.001). On multivariate analysis, Black (OR 1.21, 95%CI 1.01–1.46) or Hispanic race (OR 1.37, 95% CI 1.02–1.84), high socioeconomic vulnerability (OR 1.18, 95% CI 1.01 – 1.40), a history of substance/alcohol abuse (OR 1.35, 95%CI 1.01–1.82), a history of chronic pain (OR 1.26, 95% CI 1.09 – 1.44), dual Medicare and Medicaid eligibility (OR 1.76, 95%CI 1.53–2.03), and a higher perioperative opioid dose (OR 1.44, 95%CI 1.23–1.69) were all associated with greater odds of NPOU after surgery. After controlling for competing risks factors, patients who developed NPOU were more likely to re-present to the emergency department due to falls, respiratory, and opioid-related conditions (1.31, 95% CI 1.10–1.55), as well as have a higher risk of long-term mortality (HR 2.01, 95% CI 1.72–2.37) versus non-NPOU patients (Figure).


Conclusions: Roughly 1 in 16 patients experienced NPOU after surgery for a GI cancer. NPOU was associated with increased risk of subsequent emergency department visits, as well as higher mortality. Targeted interventions for individuals at highest risk for NPOU after surgery should be employed to help mitigate the harmful effects of NPOU.

Learning Objectives:

  • Upon completion, participant will be able to identify patients at a higher risk of developing new persistent opioid use following gastrointestinal surgery.
  • Upon completion, participant will be able to define the risk of mortality in patients who develop new, persistent opioid use following gastrointestinal surgery.
  • Upon completion, participant will be able to define the risks of emergency department revisits in patients with new and persistent opioid use following gastrointestinal surgery.