Cardiovascular Outcomes Research Laboratories (CORELAB), Division of Cardiac Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA.
Department of Surgery, Los Angeles County Harbor-UCLA Medical Center, Torrance, California, USA.
Heart. 2021 Jun;107(11):909-915. doi: 10.1136/heartjnl-2020-317618. Epub 2020 Oct 29.
While opioid use disorder (OUD) has been previously associated with increased morbidity and resource use in cardiac operations, its impact on readmissions is understudied.
Patients undergoing coronary artery bypass grafting and valve repair or replacement, excluding infective endocarditis, were identified in the 2010-16 Nationwide Readmissions Database. Using International Classification of Diseases 9/10, we tabulated OUD and other characteristics. Multivariable regression was used to adjust for differences.
Of an estimated 1 978 276 patients who had cardiac surgery, 5707 (0.3%) had OUD. During the study period, the prevalence of OUD increased threefold (0.15% in 2010 vs 0.53% in 2016, parametric trend<0.001). Patients with OUD were more likely to be younger (54.0 vs 66.0 years, p<0.001), insured by Medicaid (28.2 vs 6.2%, p<0.001) and of the lowest income quartile (33.6 vs 27.1%, p<0.001). After multivariable adjustment, OUD was associated with decreased mortality (1.5 vs 2.7%, p=0.001). Although these patients had similar rates of overall complications (36.1 vs 35.1%, p=0.363), they had increased thromboembolic (1.3 vs 0.8%, p<0.001) and infectious (4.1 vs 2.8%, p<0.001) events, as well as readmission at 30 days (19.0 vs 13.2%, p<0.001). While patients with OUD had similar hospitalisation costs ($50 766 vs $50 759, p=0.994), they did have longer hospitalisations (11.4 vs 10.3 days, p<0.001).
The prevalence of OUD among cardiac surgical patients has steeply increased over the past decade. Although the presence of OUD was not associated with excess mortality at index hospitalisation, it was predictive of 30-day readmission. Increased attention to predischarge interventions and care coordination may improve outcomes in this population.
虽然阿片类药物使用障碍（OUD）先前与心脏手术中的发病率和资源利用增加有关，但它对再入院的影响仍研究不足。
在 2010-16 年全国再入院数据库中，确定了接受冠状动脉旁路移植术和瓣膜修复或置换的患者，但不包括感染性心内膜炎患者。使用国际疾病分类第 9/10 版，我们列出了 OUD 和其他特征。多变量回归用于调整差异。
在估计有 1978276 例心脏手术的患者中，有 5707 例（0.3%）患有 OUD。在研究期间，OUD 的患病率增加了三倍（2010 年为 0.15%，2016 年为 0.53%，参数趋势<0.001）。患有 OUD 的患者更年轻（54.0 岁 vs 66.0 岁，p<0.001），由医疗补助保险（28.2% vs 6.2%，p<0.001）和收入最低的四分位数（33.6% vs 27.1%，p<0.001）覆盖。经过多变量调整后，OUD 与死亡率降低相关（1.5% vs 2.7%，p=0.001）。尽管这些患者的总体并发症发生率相似（36.1% vs 35.1%，p=0.363），但他们发生血栓栓塞（1.3% vs 0.8%，p<0.001）和感染（4.1% vs 2.8%，p<0.001）事件的风险增加，30 天再入院率（19.0% vs 13.2%，p<0.001）也增加。虽然患有 OUD 的患者的住院费用相似（$50766 美元 vs $50759 美元，p=0.994），但他们的住院时间更长（11.4 天 vs 10.3 天，p<0.001）。
在过去十年中，心脏手术患者中 OUD 的患病率急剧上升。尽管 OUD 的存在与指数住院期间的超额死亡率无关，但它是 30 天再入院的预测因素。增加对出院前干预和护理协调的关注可能会改善这一人群的结局。
