Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio.
Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio.
Ann Thorac Surg. 2022 Nov;114(5):1569-1576. doi: 10.1016/j.athoracsur.2022.02.045. Epub 2022 Mar 11.
Owing to the opioid epidemic, more cardiac surgery patients present with opioid use disorder (OUD). A better understanding of national readmissions among these patients is necessary to improve outcomes and optimize resource utilization. We sought to examine the effect of OUD on readmission after cardiac surgery.
Of 555 394 cardiac surgery patients from 2016 to 2017 in the Nationwide Readmissions Database, 6082 (1.1%) presented with OUD. These patients were assessed at 30, 90, and 180 days after discharge. The OUD patients and non-OUD patients were propensity score matched for patient- and procedure-level characteristics. Kaplan-Meier curves were compared using the log rank test.
First-time readmissions were significantly higher among patients with OUD (30 days 19.7% vs 15.7%, P = .04; 90 days 31.8% vs 24.2%, P < .0001; and 180 days 42.3% vs 30.6%, P < .0001). There was a trend toward higher reoperation by 180 days, with 90% of those being isolated valve surgery. By 180 days, significantly more OUD patients had three or more readmissions (7.8% vs 4.5%) compared with non-OUD patients. Yet, only 2.4% of OUD patients received any counseling or treatment for substance abuse during the index admission. The most common readmitting diagnosis was infection (55% vs 41%, P < .0001) including endocarditis, prosthetic infections, and skin or subcutaneous infections. Respiratory failure, opioid overdose, and acute pain were also more common among patients with OUD.
Cardiac surgery patients with OUD have multiple readmissions but are rarely provided adequate addiction management during their index admission. Greater emphasis on multidisciplinary management is necessary to limit costs and morbidity associated with readmission or reoperation.
由于阿片类药物流行，更多的心脏手术患者出现阿片类药物使用障碍（OUD）。为了改善结果和优化资源利用，有必要更好地了解这些患者的全国再入院情况。我们旨在研究 OUD 对心脏手术后再入院的影响。
在 2016 年至 2017 年全国再入院数据库中，有 555394 例心脏手术患者，其中 6082 例（1.1%）患有 OUD。这些患者在出院后 30、90 和 180 天进行评估。对患者和手术水平的特征进行倾向评分匹配，比较 OUD 患者和非 OUD 患者。使用对数秩检验比较 Kaplan-Meier 曲线。
OUD 患者的首次再入院率明显较高（30 天 19.7% vs 15.7%，P=0.04；90 天 31.8% vs 24.2%，P<0.0001；180 天 42.3% vs 30.6%，P<0.0001）。到 180 天，再手术的趋势更高，其中 90%为孤立瓣膜手术。到 180 天，OUD 患者中有 7.8%的患者有三次或更多次再入院，而非 OUD 患者有 4.5%。然而，只有 2.4%的 OUD 患者在入院期间接受过任何药物滥用咨询或治疗。最常见的再入院诊断是感染（55% vs 41%，P<0.0001），包括心内膜炎、假体感染、皮肤或皮下感染。呼吸衰竭、阿片类药物过量和急性疼痛在 OUD 患者中也更为常见。
患有 OUD 的心脏手术患者多次再入院，但在入院期间很少接受适当的成瘾管理。需要更加重视多学科管理，以限制与再入院或再次手术相关的成本和发病率。
