Shabet Christina Lynn, Alessio Dominic, Kenney Brooke, Bicket Mark C, Brummett Chad M, Waljee Jennifer F
Section of Plastic Surgery, University of Michigan Department of Surgery, Ann Arbor, Michigan, USA
Overdose Prevention Engagement Network (OPEN), Ann Arbor, Michigan, USA.
Reg Anesth Pain Med. 2025 Jan 31. doi: 10.1136/rapm-2024-106199.
A high proportion of surgical patients has previous opioid exposure, which is associated with poorer recovery and increased morbidity. However, much less is known regarding the direct and indirect costs that are associated with healthcare utilization among individuals on preoperative opioid therapy.
We analyzed The Merative MarketScan Commercial Database linked with the Merative MarketScan Health and Productivity Management Database to include all adult patients admitted and discharged from common elective surgeries between January 1, 2018 and June 30, 2021. Patients were clustered by preoperative opioid exposure and estimates for total direct payments (in USD) generated and workplace absenteeism were assessed for a 6-month period.
10 737 patients were included in our cohort; 17.0% classified as 'low' preoperative opioid use (median oral morphine equivalents (IQR)=126 (75-225)), 5.0% as 'medium' (370 (225-640)) and 3.0% as 'high' (4500 (2120-10 908)). Compared with opioid naive or low preoperative use, individuals with high preoperative use had significantly higher estimated payments for care at 6 months ($4212 for high vs $2706 for naive (p=0.007) and $3059 for low (p=0.045)), while utilizing increased ambulatory care including clinic and outpatient visits after surgery. There was no significant difference in workplace absenteeism between groups.
High preoperative opioid use is associated with increased healthcare utilization and costs following common elective surgery. Future efforts should focus on this patient population to explore interventions that could optimize value-based care by improving outcomes and reducing costs.
很大一部分外科手术患者既往有阿片类药物使用史，这与较差的恢复情况及发病率增加相关。然而，对于术前接受阿片类药物治疗的个体，与医疗保健利用相关的直接和间接成本却知之甚少。
我们分析了与默克市场扫描健康与生产力管理数据库相关联的默克市场扫描商业数据库，纳入了2018年1月1日至2021年6月30日期间接受常见择期手术并出院的所有成年患者。根据术前阿片类药物暴露情况对患者进行分组，并评估6个月期间产生的总直接费用（以美元计）和工作场所缺勤情况。
我们的队列纳入了10737例患者；17.0%被归类为术前阿片类药物低用量组（口服吗啡当量中位数（四分位间距）=126（75-225）），5.0%为中用量组（370（225-640）），3.0%为高用量组（4500（2120-10908））。与未使用阿片类药物或术前低用量患者相比，术前高用量患者在6个月时的护理估计费用显著更高（高用量组为4212美元，未使用组为2706美元（p=0.007），低用量组为3059美元（p=0.045）），同时术后使用的门诊护理（包括诊所和门诊就诊）有所增加。各组之间的工作场所缺勤情况无显著差异。
术前高剂量使用阿片类药物与常见择期手术后医疗保健利用率和成本增加相关。未来的工作应聚焦于这一患者群体，探索通过改善治疗效果和降低成本来优化基于价值的医疗保健的干预措施。
