Preoperative Opioid Use Disorder Is Associated With Poorer Outcomes After Coronary Bypass and Valve Surgery: A Multistate Analysis, 2007-2014.

OBJECTIVE

To determine the effect of preoperative opioid use disorder (OUD) on postoperative outcomes in patients undergoing coronary artery bypass grafting (CABG) and heart valve surgery.

DESIGN

Retrospective, observational study using data from the State Inpatient Database and the Healthcare Cost and Utilization Project.

SETTING

Inpatient data from Florida, California, New York, Maryland, and Kentucky between 2007 and 2014.

PARTICIPANTS

A total of 377,771 CABG patients and 194,469 valve surgery patients age ≥18 years.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The prevalence of OUD was 2,136 (0.57%) in the CABG group and 2,020 (1.04%) in the valve surgery group. There was no significant difference in mortality between the OUD and non-OUD groups in both surgical cohorts (both p > 0.05). On adjusted analyses, preoperative OUD was significantly associated with increased adjusted odds ratios (aORs) of 30-day hospital readmission (CABG aOR 1.47 [95% confidence interval {CI} 1.30-1.66]; valve surgery aOR 1.41 [95% CI 1.27-1.56]) and 90-day hospital readmission (CABG aOR 1.47 [95% CI 1.31-1.64]; valve surgery aOR 1.33 [95% CI 1.23-1.43]). Preoperative OUD was significantly associated with increased adjusted risk ratios (aRRs) of hospital length of stay (CABG aRR 1.13 [95% CI 1.10-1.16]; valve surgery aRR 1.63 [95% CI 1.54-1.72]) and total hospitalization charges (CABG aRR 1.05 [95% CI 1.03-1.07]; valve surgery aRR 1.28 [95% CI 1.24-1.32]).

CONCLUSION

Preoperative OUD is significantly associated with poorer outcomes after cardiac surgery, including increased 30- and 90-day readmissions, hospital length of stay, and total hospitalization charges. Opioid use should be considered a modifiable risk factor in cardiac surgery, and interventions should be attempted preoperatively.