Xcenda, 4114 Woodlands Pkwy., Ste. 500, Palm Harbor, FL 34685.
J Manag Care Spec Pharm. 2014 Sep;20(9):948-58. doi: 10.18553/jmcp.2014.20.9.948.
Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs.
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.
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 greater than 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.
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 low-risk 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.
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.
阿片类药物相关不良药物事件（ORADEs）是住院和增加医疗保健费用的常见原因。
（a）估计接受术后阿片类药物的胃肠道（GI）手术患者中特定不良药物事件（ADE）的发生率；（b）检查风险评分模型在将高风险 ORADEs 患者分类方面的效用；（c）根据住院费用、住院时间（LOS）和 30 天再入院率，量化针对高风险 GI 手术患者进行阿片类药物节约方案的潜在临床/经济效益。
使用基于行政数据库的回顾性设计，纳入 2010 年 1 月 1 日至 2010 年 12 月 31 日期间接受住院手术的患者。对年龄大于 18 岁的 GI 手术患者，从入院到出院后 30 天进行特征描述，根据临床/人口统计学特征将其归类为高风险或低风险，并评估几种结果。使用多变量逻辑回归，比较高风险和低风险患者的 ORADE 发生率、总住院费用、LOS 和 30 天再入院率。
在 87.8%（n=3235）的手术人群中，风险分配与 ORADE 发生率之间存在很强的一致性。在其余 12.2%（n=449）的患者中，5.5%（n=202）为低风险且发生 ORADE，6.7%（n=247）为高风险且未发生 ORADE。总体而言，20.6%（n=344）的高风险患者经历了≥1 次 ORADE（平均费用：31988 美元；LOS：12.1 天），而低风险患者只有 5.3%（n=107）（平均费用：25216 美元；LOS：8.0 天）。高风险患者的住院费用和 LOS 分别高于低风险患者（平均费用：19234 美元比 13036 美元；平均 LOS：6.8 天比 3.3 天）。这些差异对应于高风险患者的成本增加 47.0%，LOS 大约是低风险患者的两倍。
患者的临床/人口统计学特征影响 ORADE 发生的风险。风险评估工具可以有效地识别高风险患者，从而实施可以减少 ORADE、降低住院费用和改善患者术后体验的干预措施。
