Patients With Opioid Use Disorder Have Increased Readmission Rates, Emergency Room Visits, and Costs Following a Hallux Valgus Procedure

Background Patients with a history of opioid use disorder (OUD) tend to have more complications, higher readmission rates, and increased costs following orthopaedic procedures. This study evaluated patients undergoing hallux valgus correction for their odds of increased (1) readmission rates, (2) emergency room (ER) visits, and (3) costs. Methods Patients undergoing hallux valgus corrections with OUD history were identified using a national Medicare administrative claims database of approximately 24 million orthopaedic surgery patients. OUD patients were matched to non–opioid use disorder (NUD) patients in a 1:4 ratio by age, sex, Elixhauser-Comorbidity Index (ECI), diabetes mellitus, hyperlipidemia, hypertension, and tobacco use. The query yielded 6318 patients (OUD = 1276; NUD = 5042) who underwent a hallux valgus correction. Primary outcomes analyzed included odds of 90-day readmission rates, 30-day ER visits, and 90-day episode-of-care costs. Demographics, odds ratios (ORs), ECI, and cost were assessed as appropriate using a Pearson χ2 test, logistic regression, and a t test. A P value <.05 was considered statistically significant. Results There were no significant differences in demographics between OUD and NUD patients. OUD patients had higher incidence and odds of 90-day readmission (9.56% vs 6.04%; OR = 1.55; P < .001) and 30-day ER visits (0.86% vs 0.35%; OR = 2.42; P = .021) and incurred greater 90-day episode-of-care costs ($7208.28 vs $6134.75; P < .001) compared with NUD patient controls. Conclusion The study demonstrates the possible influence of OUD on higher odds of readmission, ER visits, and costs following a hallux valgus correction. Levels of Evidence Level III: Retrospective cohort study

Download Full-text

Patients with Opioid Use Disorder Have Increased Readmission Rates, Emergency Room Visits, and Costs Following Hallux Valgus Procedures

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00380 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0038

Author(s):

James M. Parrish ◽

Rushabh M. Vakharia ◽

Dillon Benson ◽

Aaron K. Hoyt ◽

Nathaniel W. Jenkins ◽

...

Keyword(s):

Emergency Room ◽

Hallux Valgus ◽

Opioid Use Disorder ◽

Orthopedic Procedures ◽

Emergency Room Visits ◽

Opioid Use ◽

Readmission Rates ◽

Episode Of Care ◽

History Of ◽

Care Costs

Category: Ankle; Bunion; Midfoot/Forefoot; Other Introduction/Purpose: Patients with a history of opioid use disorder (OUD) have been shown to incur more severe medical complications, higher readmission rates, and increased cost following various orthopedic procedures. There is a scarcity in the literature investigating the effects of OUD following a hallux valgus procedure. Therefore, the purpose of this study was to evaluate whether OUD patients undergoing a hallux valgus correction are at greater odds of: 1) readmission rates, 2) emergency room (ER) visits, and 3) costs. Methods: Patients undergoing a hallux valgus correction with a history of OUD were identified using a health insurance claims database. To search for patients undergoing hallux valgus surgical corrections the following current procedural terminology (CPT) medical codes were used: 28290, 28292, 28293, 28294, 28296, 28297, 28298, 28299, 28306, and 28307. To include all eligible patients the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes were also utilized, including: 77.51 and 77.59. OUD patients were matched to non-opioid use disorder (NUD) patients in a 1:4 ratio by age, sex, Elixhauser-Comorbidity Index (ECI), diabetes mellitus, hyperlipidemia, hypertension, and tobacco use. Primary outcomes analyzed included odds of 90-day readmission rates, 30-day emergency room visit, and 90-day episode of care costs. Pearson’s chi-squared test was used to compare demographics. Logistic regression analysis calculated odds-ratios for readmission and ER visits. Welch’s t-test was used for significance in ECI and cost between cohorts. Results: The query yielded 6,318 patients (OUD=1,276; NUD=5,042) who underwent a hallux valgus correction. There were no significant difference between any of the compared age ranges (p=0.859, p=0.952, p=0.909, p=0.961), ECI (p=1.000) and comorbidities between OUD and NUD patients. OUD patients had higher incidence and odds of 90-day readmission rates (9.56 vs. 6.04%; OR: 1.55, p<0.001) and 30-day ER visits (.86 vs. .35%; OR: 2.42, p=0.021) compared to controls. OUD patients also incurred significantly greater 90-day episode of care costs ($7,208.28 vs. $6,134.75, p<0.0001) compared to NUD patients. Conclusion: Patients with a history of OUD who underwent a hallux valgus correction had a higher odds ratio of 90-day readmission rates, 30-day emergency room visits, and 90-day total global episode of care cost compared to those with NUD. These findings expand on a rapidly growing body of current literature that demonstrate OUD increases numerous costs associated with outcomes of foot and ankle surgery. OUD is a risk factor for poor post operative outcomes for patients undergoing a hallux valgus correction. The findings of this study are likely to improve preoperative counseling and selection when addressing patients with preoperative opioid use. [Table: see text]

Download Full-text

The Influence of Opioid Use Disorder on Open Reduction and Internal Fixation Following Ankle Fracture

Foot & Ankle Specialist ◽

10.1177/1938640020914715 ◽

2020 ◽

pp. 193864002091471

Author(s):

Megan K. Allen ◽

James M. Parrish ◽

Rushabh Vakharia ◽

Jonathan R. M. Kaplan ◽

Ettore Vulcano ◽

...

Keyword(s):

Emergency Room ◽

Internal Fixation ◽

Open Reduction ◽

Opioid Use Disorder ◽

Cost Of Care ◽

Administrative Claims ◽

Emergency Room Visits ◽

Opioid Use ◽

Readmission Rates ◽

Costs Of Care

Background. Ankle fractures are common and may require open reduction and internal fixation (ORIF). Literature is scarce evaluating the associations of opioid use disorder (OUD) with ORIF postoperative outcomes. This study investigates whether OUD patients have increased (1) costs of care, (2) emergency room visits, and (3) readmission rates. Methods. ORIF patients with a 90-day history of OUD were identified using an administrative claims database. OUD patients were matched (1:4) to controls by age, sex, and medical comorbidities. The Welch t-test determined the significance of cost of care. Logistic regression yielded odds ratios (ORs) for emergency room visits and 90-day readmission rates. Results. A total of 2183 patients underwent ORIF (n = 485 with OUD vs n = 1698 without OUD). OUD patients incurred significantly higher costs of care compared with controls ($5921.59 vs $5128.22, P < .0001). OUD patients had a higher incidence and odds of emergency room visits compared with controls (3.50% vs 0.64%; OR = 5.57, 95% CI = 2.59-11.97, P < .0001). The 90-day readmission rates were not significantly different between patients with and without OUD (8.65% vs 7.30%; OR = 1.20, 95% CI = 0.83-1.73, P = .320). Conclusion. OUD patients have greater costs of care and odds of emergency room visits within 90 days following ORIF. Levels of Evidence: Level III: Retrospective cohort study

Download Full-text

The Influence of Opioid Use Disorder on Open Reduction and Internal Fixation following Ankle Fracture

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00103 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0010

Author(s):

Megan K. Allen ◽

James M. Parrish ◽

Rushabh M. Vakharia ◽

Jonathan R. Kaplan ◽

Ettore Vulcano ◽

...

Keyword(s):

Emergency Room ◽

Ankle Fracture ◽

Open Reduction ◽

Opioid Use Disorder ◽

Foot And Ankle ◽

Emergency Room Visits ◽

Opioid Use ◽

Readmission Rates ◽

Costs Of Care ◽

History Of

Category: Ankle; Other Introduction/Purpose: Ankle fractures are common injuries that may require surgical treatment consisting of open reduction and internal fixation (ORIF). Injuries associated with increased pain levels are also correlated with increased opioid use, which is also recognized as a risk factor for bone fracture. There is a paucity of literature evaluating the impact of patients with a history of opioid use disorder (OUD) on postoperative complications following ORIF for ankle fracture. This study aims to investigate whether OUD patients are at greater odds of: 1) readmission rates, 2) emergency room visits, and 3) costs of care. Methods: Patients undergoing ORIF for ankle fracture with a 90-day history of OUD prior to the procedure were identified using national health insurance claims database. We selected patients that underwent surgical corrections as recorded by the following current procedural terminology (CPT) medical codes: 27792, 27814, 27822, 27823, 27766, 27829, and 27769. We matched cases with OUD to controls with a 1:4 of OUD to non-OUD controls. Variables that were matched between non-controls and controls included age, sex, Elixhauser- Comorbidity Index (ECI), in addition to comorbidities including diabetes, hyperlipidemia, hypertension, and tobacco usage. Logistic regression analysis was used to calculate odds-ratios (OR) for outcomes of 90-day readmission rates and emergency room visits. Welch’s t-test was used to test for significance of outcomes of cost of care and ECI between the cohorts. A p-value less than 0.001 was statistically significant. Results: A total of 2,198 patients were included with (n= 485) and without (n = 1,698) OUD undergoing ORIF for ankle fracture (Table 1). OUD patients undergoing ORIF for ankle fractures were found to have a higher incidence and odds of 90-day readmission rates compared to controls (8.65 vs. 7.30%; OR: 1.20, 95%CI: 0.83 - 1.73, p=0.320), but failed to reach statistical significance. OUD patients were found to have a higher incidence and odds of emergency room visits compared to controls (3.50 vs. 0.64%; OR: 5.57, 95% CI: 2.59 - 11.97, p<0.0001). OUD patients also incurred significantly higher costs of care compared to controls ($5,921.59 vs. $5,128.22, p<0.0001). Conclusion: Patients with OUD have greater odds of 90-day hospital readmission rates, emergency room visits, and costs of care following ORIF procedures for ankle fracture. These outcomes are consistent with previous research which found increased costs associated with individuals diagnosed with OUD prior to undergoing other foot and ankle procedures. This study, establishes that patients with OUD place a significant, but preventable, financial burden on healthcare resources. The findings of this study highlight the role that foot and ankle orthopaedic surgeons can play in reducing healthcare costs and improving patient outcomes by addressing OUD prior to the occurrence of injury. [Table: see text]

Download Full-text

Opioid Use Disorder in Patients Undergoing Primary 1- to 2-Level Anterior Cervical Discectomy and Fusion Is Associated With Longer In-Hospital Lengths of Stay and Higher Rates of Readmissions, Complications, and Costs of Care

Global Spine Journal ◽

10.1177/21925682211037265 ◽

2021 ◽

pp. 219256822110372

Author(s):

Nathan S. Kim ◽

Aaron W. Lam ◽

Ivan J. Golub ◽

Bhavya K. Sheth ◽

Rushabh M. Vakharia ◽

...

Keyword(s):

Opioid Use Disorder ◽

Anterior Cervical Discectomy ◽

Medical Complications ◽

Opioid Use ◽

Readmission Rates ◽

Cervical Discectomy ◽

Lengths Of Stay ◽

Episode Of Care ◽

Safe Discontinuation ◽

Medicare Database

Study Design: Retrospective study. Objective: To determine whether opioid use disorder (OUD) patients undergoing 1- to 2-level anterior cervical discectomy and fusion (1-2ACDF) have higher rates of: 1) in-hospital lengths of stay (LOS); 2) readmissions; 3) complications; and 4) costs. Methods: OUD patients undergoing primary 1-2ACDF were identified within the Medicare database and matched to a control cohort in a 1:5 ratio by age, sex, and medical comorbidities. The query yielded 80,683 patients who underwent 1-2 ACDF with (n = 13,448) and without (n = 67,235) OUD. Outcomes analyzed included in-hospital LOS, 90-day readmission rates, 90-day medical complications, and costs. Multivariate logistic regression analyses were used to calculate odds-ratios (OR) for medical complications and readmissions. Welch’s t-test was used to test for significance for LOS and cost between the cohorts. An alpha value less than 0.002 was considered statistically significant. Results: OUD patients were found to have significantly longer in-hospital LOS compared to their counterparts (3.41 vs. 2.23-days, P < .0001), in addition to higher frequency and odds of requiring readmissions (21.62 vs. 11.57%; OR: 1.38, P < .0001). Study group patients were found to have higher frequency and odds of developing medical complications (0.88 vs. 0.19%, OR: 2.80, P < .0001) and incurred higher episode of care costs ($20,399.62 vs. $16,812.14, P < .0001). Conclusion: The study can help to push orthopaedic surgeons in better managing OUD patients pre-operatively in terms of safe discontinuation and education of opioid drugs and their effects on complications, leading to more satisfactory outcomes.

Download Full-text

The Effects of Opioid Use on Thromboembolic Complications, Readmission Rates, and 90-Day Episode of Care Costs After Total Hip Arthroplasty

The Journal of Arthroplasty ◽

10.1016/j.arth.2020.02.014 ◽

2020 ◽

Vol 35 (6) ◽

pp. S237-S240

Author(s):

Nipun Sodhi ◽

Hiba K. Anis ◽

Alexander J. Acuña ◽

Rushabh M. Vakharia ◽

Nicolas S. Piuzzi ◽

...

Keyword(s):

Total Hip Arthroplasty ◽

Hip Arthroplasty ◽

Thromboembolic Complications ◽

Opioid Use ◽

Readmission Rates ◽

Total Hip ◽

Episode Of Care ◽

Care Costs

Download Full-text

Effects of Venous Insufficiency in Patients Undergoing Primary Total Knee Arthroplasty: An Analysis of 1.2 Million Patients

The Journal of Knee Surgery ◽

10.1055/s-0041-1733901 ◽

2021 ◽

Author(s):

Spencer Summers ◽

Ramakanth Yakkanti ◽

Justin Ocksrider ◽

Sagie Haziza ◽

Angelo Mannino ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Venous Insufficiency ◽

Medical Complications ◽

Administrative Claims ◽

Readmission Rates ◽

Costs Of Care ◽

Episode Of Care ◽

Total Knee ◽

Care Costs

AbstractChronic venous insufficiency (CVI) is extraordinarily prevalent in our aging population with over 30 million people in the United States suffering from the disease. There is a paucity of data analyzing the effects of CVI on outcomes following total knee arthroplasty (TKA). The purpose of this study was to utilize a nationwide administrative claims database to determine whether patients with CVI undergoing TKA have higher rates of: (1) in-hospital lengths of stay (LOS); (2) readmission rates; (3) medical complications; (4) implant-related complications; and (5) costs of care compared to controls. Using a nationwide database, we matched patients with CVI undergoing TKA to controls without CVI undergoing TKA in a 1:5 ratio by age, sex, and medical comorbidities associated with CVI. Primary outcomes analyzed within the study included LOS, 90-day readmission rates, 90-day medical complications, 2-year implant-related complications, in addition to 90-day total global episode of care costs. The query yielded 1,265,534 patients with (n = 210,926) and without (n = 1,054,608) CVI undergoing primary TKA. Patients with CVI had significantly longer LOS (4 vs. 3 days, p < 0.0001), higher 90-day readmission rates (20.96 vs. 15.34%; odds ratio [OR]: 1.46, 95% confidence interval [CI]: 1.44–1.48, p < 0.0001), and higher odds of medical complications (2.27 vs. 1.30%; OR: 1.76, 95% CI: 1.70–1.83, p < 0.0001) compared to matched controls. Patients with CVI also had higher odds of periprosthetic joint infections (2.23 vs. 1.03%; OR: 2.18, p < 0.0001) and implant-related complications in general (4.27 vs. 2.17%; OR: 2.01, 95% CI: 1.96–2.06, p < 0.0001). Additionally, patients with CVI had higher total global 90-day episode of care costs ($15,583.07 vs. $14,286.95, p < 0.0001). Patients with CVI undergoing TKA have increased LOS, higher odds of medical and implant complications, and increased costs of care compared to those without CVI. The study can be utilized by orthopaedic surgeons to counsel patients on the potential complications following this procedure. This is a level III, retrospective cohort study.

Download Full-text

Implant-related complications in patients with opioid use disorder undergoing primary shoulder arthroplasties: a matched-controlled analysis

Shoulder & Elbow ◽

10.1177/1758573221994790 ◽

2021 ◽

pp. 175857322199479

Author(s):

Samuel J Swiggett ◽

Matthew L Ciminero ◽

Miriam D Weisberg ◽

Rushabh M Vakharia ◽

Ramin Sadeghpour ◽

...

Keyword(s):

Shoulder Arthroplasty ◽

Healthcare Providers ◽

Opioid Use Disorder ◽

P Value ◽

Opioid Use ◽

Readmission Rates ◽

Costs Of Care ◽

Lengths Of Stay ◽

Shoulder Arthroplasties ◽

Medicare Database

Background The purpose of this study was to investigate whether patients undergoing primary shoulder arthroplasty with opioid use disorder have higher rates of (1) implant-related complications; (2) in-hospital lengths of stay; (3) readmission rates; and (4) costs of care. Methods Opioid use disorder patients undergoing primary shoulder arthroplasty were queried and matched in a 1:5 ratio to controls by age, sex, and medical comorbidities within the Medicare database. The query yielded 25,489 patients with ( n = 4253) and without ( n = 21,236) opioid use disorder. Primary outcomes analyzed included: 2-year implant related complications, in-hospital lengths of stay, 90-day readmission rates, and 90-day costs of care. A p value less than 0.01 was considered statistically significant. Results Opioid use disorder patients had significantly longer in-hospital lengths of stay (3 days vs. 2 days; p < 0.0001) compared to matched controls. Opioid use disorder patients were also found to have higher incidence and odds (OR) of readmission rates (12.84 vs. 7.45%; OR: 1.16, p < 0.0001) and implant-related complications (20.03 vs. 7.95%; OR: 1.82, p < 0.0001). Study group patients also incurred significantly higher 90-day costs of care ($16,918.85 vs. $15,195.37, p < 0.0001). Discussion This study can be used to help further augment efforts to reduce opioid prescriptions from healthcare providers in shoulder arthroplasty settings.

Download Full-text

Demographic characteristics, medical and psychiatric history of patients with prescription opioid use disorder

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1025 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S300-S301

Author(s):

S. Herrera ◽

A. Riquelme ◽

T. León ◽

M. Babul

Keyword(s):

Opioid Analgesics ◽

The United States ◽

Opioid Use Disorder ◽

Demographic Characteristics ◽

Prescription Opioid ◽

Psychiatric History ◽

Opioid Use ◽

History Of ◽

Competing Interest ◽

Prescription Opioid Misuse

IntroductionOver the past two decades the prescription of opioid analgesics has increased with a subsequent escalating in prescription opioid misuse. It is estimated that 4.5 million (2.5%) of the United States of America population abuse of pain relievers; opioids are among the most commonly.In Chile there are few reports about the prevalence of opioid use disorder.ObjectivesThe aim of this study is to describe the demographic characteristics, medical and psychiatric comorbidity of patients that suffer from opioid addiction.Patients and methodsThis transversal study examined data of 7 patients with opioid use disorder (OUD; DSM-5) that consulted at the addiction unit of “Red de Salud, Pontificia Universidad Católica de Chile”, between November 2013 and October 2015. Data included: demographics, medical and psychiatric history, laboratory and imaging tests.ResultsOf all the patients, 57% were men, 25 to 67 years of age, 43% between 35-40 years; 57% were married; 57% had completed studies at university. 43% had also alcohol use disorder, 28% marijuana, 28% cocaine and 28% benzodiazepines than in most cases began before OUD. In addition; 57% had medical comorbidity among which stand out obesity (17%), osteoarthritis (17%) and chronic low back pain (17%). Eighty-three percent require hospitalization. Twenty-eight percent had abnormal liver tests and one patient had positive hepatitis B core antibody. Opioids used were: morphine(14%), codeine (43%), tramadol (42%).ConclusionThese results emphasize on the misuse of prescription opioids analgesics, the complexity of patients with OUD and the prevalence of other substance use disorder that precedes and accompany OUD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Download Full-text