Dewan KC, et al. - The national population of cardiac surgery patients with opioid use disorder (OUD) was characterized and compared with the cardiac surgery population without OUD in terms of outcomes. Over the past decade, an increase in the population of patients with persistent opioid use or opioid dependency undergoing cardiac surgery was observed. Patients with OUD can undergo cardiac surgery safely but display a higher risk for complication and at a higher cost. Hence, they recommend careful monitoring of these patients postoperatively for complications rather than denial to surgery because of OUD status.

Methods

• Researchers performed a retrospective population-based cohort study of more than 5.7 million adult patients who underwent cardiac surgery (ie, coronary artery bypass graft, valve surgery, or aortic surgery) in the United States.
• Exclusion of pregnant patients was performed.
• They performed propensity matching to compare cardiac surgery patients with OUD (n = 11 359) and without OUD (n = 5,707,193) regarding outcomes.
• From January 1998 to December 2013, they searched the Nationwide Inpatient Sample database.
• Data analysis was performed in January 2018.
• They assessed in-hospital mortality, complications, length of stay, costs, and discharge disposition as main outcomes and measures.

Results

• Researchers included 5,718,552 patients comprising 3,887,097 (68.0%) males; patients with OUD had mean (SD) age of 47.67 (13.03) years and patients without OUD had mean (SD) age of 65.53 (26.14) years.
• Among cardiac surgery patients, OUD prevalence of 0.2% (n = 11,359) was observed, with an 8-fold increase over 15 years (0.06% [262 of 437 641] in 1998 vs 0.54% [1425 of 263 930] in 2013; difference, 0.48%; 95% CI of difference, 0.45-0.51; P < .001).
• Relative to patients without OUD, patients with OUD were younger (mean [SD] age, 48 [0.30] years vs 66 [0.05] years; P < .001) and more often male (70.8% vs 68.0%; P < .001), black (13.7% vs 4.8%), or Hispanic (9.1% vs 4.8%).
• Patients with OUD fell in the first quartile of median income (30.7% vs 17.1%; P < .001) more frequently and were more frequently uninsured or Medicaid beneficiaries (48.6% vs 7.7%; P < .001).
• Patients with OUD more commonly underwent valve and aortic operations (49.8% vs 16.4%; P < .001).
• Among propensity-matched pairs, patients with vs without OUD displayed similar mortality (3.1% vs 4.0%; P = .12).
• An overall higher incidence of major complications was noted for cardiac surgery patients with OUD (67.6% vs 59.2%; P < .001); specifically, these patients were at significantly higher risks of blood transfusion (30.4% vs 25.9%; P=.002), pulmonary embolism (7.3% vs 3.8%; P < .001), mechanical ventilation (18.4% vs 15.7%; P=.02), and prolonged postoperative pain (2.0% vs 1.2%; P=.048).
• A significantly longer length of stay (median [SE], 11 [0.30] vs 10 [0.22] days; P < .001) and cost significantly more per patient (median [SE], $49 790 [1059] vs $45 216 [732]; P < .001) were evident for patients with OUD.