New research suggests that people who use opioids before elective surgery struggle with a variety of post-operative issues; longer hospital stays and a higher chance of needing follow-up care in a hospital or rehabilitation facility, not to mention increased costs all around. To be specific, they found a positive correlation between an Opioid addiction and increased costs; opioid users cost up to double or triple the amount of non-opioid users. This is according to a new study published in the “Annals of Surgery” by a team from the University of Michigan Institute for Healthcare Policy and Innovation. They found that the exact opposite was true for patients who were not taking opioid medications prior to elective surgery.
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Opioid Addiction- A New Pre-Operative Risk Factor
When these new findings are combined with past research on pre-operative opioid use prior to other types of surgery it leads to only one conclusion; pre-operative opioid use must be considered as a significant risk factor. Normally before elective surgery, doctors will consider the usual known risk factors and discuss them with their patients carefully. Patients are always made aware of risk factors such as smoking, anticoagulant use, and general medical conditions. But Dr. Jennifer Waljee, M.D., M.S., lead author of the study and a plastic surgeon at the University of Michigan’s academic medical center, says “these findings suggest that perhaps pre-operative opioid use warrants the same awareness.” She went on to explain that some options for patients using opioids prior to surgery could be to taper down doses or to consider alternative approaches to pain relief such as non-narcotic prescription drugs.
Dr. Waljee also explained that physicians should be extremely cautious when developing their plan to manage opioid users pain during the perioperative period. The perioperative period consists of the duration of the patient’s surgical procedure, and also includes pre-operative care (admission into the hospital, anesthesia, administering of any other necessary drugs, hair removal if necessary) and post-operative care (reversal of anesthesia, monitoring patient’s vital signs and observing the patient for signs of infection.) Since regular opioid users quickly develop a tolerance to these powerful and addictive drugs, they may require a higher dose than the average patient. Someone with an Opioid addiction will also have a lower pain threshold, leaving them more vulnerable after an operation. Dr. Waljee and her colleagues at the University of Michigan have undergone a massive effort to promote a better understanding of opioid users needs in the context of surgery and to help surgeons prescribe opioids more wisely. Dr. Waljee is one of the few surgeons with a sophisticated and nuanced understanding of patients who come to her already using opioids.
Before the Michigan Department of Health and Human Services decided to fund this study along with the Institute for Healthcare Policy Innovation, the authors of the study identified similar trends in Michigan hospitals. They were able to access data from a study published by David Cron in July of 2016. The study showed that the 21% of patients who used opioids prior to surgery had a substantially higher risk of complications, readmissions, and higher costs.
Dollars and Cents
For the new study, the authors utilized national claims data taken from private insurance companies. They studied the records of over 200,000 middle-class Americans who had undergone common operations (hysterectomies, bariatric surgery, hernia repair, and reflux surgery) over a 42-month period. Within the first 90 days, costs were three times higher for those who had been using opioids before surgery. Even an entire year later, those who had used opioids before surgery had an average cost of $25,000, while non-opioid users had an average cost of $12,113. These numbers indicate a pattern of higher medical costs in general for those who use opioids at any point.
Most of the content I write is in regards to horror stories about opioid use. Addiction in our society and around the world leads to higher incarceration rates, higher rates of accidents and injuries and of course more deaths. But not every consequence of addiction is so extreme. In this case, we’re referring to a specific medical issue; post-operative care. It is difficult to find definitive answers regarding how many surgical procedures the average person will need in their lifetime. One study conducted by two Boston-based doctors, Dr. Peter Lee and Dr. Atul Gawande, stated that the average person will need approximately 9.2 surgeries in their lifetime. This study assumed that the average lifespan for Americans is 85 years and that healthcare trends will remain constant.
The truth is that the more we learn and the more technology that develops, Americans will continue to live longer and longer as time goes on. When you combine this fact with our current opioid addiction crisis, this makes the medical costs associated with surgery much more significant.
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