Association Between Opioid Use Disorder and Healthcare Spending and Utilization in Emergency Surgical Patients: A Retrospective Analysis Using Commercial Claims.

OBJECTIVE

To estimate the association between opioid use disorder (OUD) and healthcare spending and utilization in emergency surgical patients, and to evaluate whether the use of opioid agonist treatment (OAT) modifies this relationship.

BACKGROUND

Surgical patients with OUD are susceptible to challenging postoperative pain management and relapse. Their healthcare spending and utilization estimates may justify perioperative system optimization efforts.

METHODS

We identified 142,726 patients who underwent 1 of 14 surgeries between January 1, 2016 and December 31, 2021. We then estimated the association between OUD and primary outcomes (spending during the surgical admission and in the 1-90 days postdischarge) and secondary outcomes (measures of healthcare utilization). We further evaluated whether the use of OAT modified the relationship between OUD and outcomes.

RESULTS

Those with without OUD had no difference in spending during the surgical admission [-1%; 95% confidence interval (CI) = -7% to +4%; = 0.644]. However, in the postdischarge period, those with OUD had 38% higher spending (95% CI = 17% to 62%; < 0.001), translating to $2,560 (95% CI = $786-$4,333; = 0.005) in incremental spending. Hospital length-of-stay was not different in those with OUD incidence risk ratio (IRR) = 0.99; 95% CI = 0.92-1.05; = 0.668), but all measures of postdischarge utilization were elevated (number of postdischarge inpatient days, IRR = 1.90; 95% CI = 1.39-2.58; < 0.001; 30-day inpatient readmission, IRR = 1.30; 95% CI = 1.06-1.60; = 0.013; and 30-day emergency department utilization (IRR = 1.28; 95% CI = 1.10-1.48; = 0.001). Point estimates for all postdischarge outcomes were lower in those with OUD who used OAT versus those with OUD who did not use OAT.

CONCLUSIONS

Emergency surgical patients with OUD had higher healthcare spending and utilization following discharge compared to those without OUD, implying an elevated risk of complications. Optimizing preoperative use of OAT may facilitate perioperative optimization and cost savings.