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

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.

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

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.

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

2020 ◽  
pp. 193864002095010
Author(s):  
James M. Parrish ◽  
Rushabh M. Vakharia ◽  
Dillon C. Benson ◽  
Aaron K. Hoyt ◽  
Nathaniel W. Jenkins ◽  
...  
Keyword(s):  
Emergency Room ◽  
Hallux Valgus ◽  
Opioid Use Disorder ◽  
P Value ◽  
Administrative Claims ◽  
Opioid Use ◽  
Readmission Rates ◽  
Episode Of Care ◽  
History Of ◽  
Care Costs

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

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

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]

Impact of Biological Sex on Complications, Lengths of Stay, Readmission Rates, and Costs of Care Following Primary Total Knee Arthroplasty

2021 ◽  
Author(s):  
Samuel J. Swiggett ◽  
Angelo Mannino ◽  
Rushabh M. Vakharia ◽  
Joseph O. Ehiorobo ◽  
Martin W. Roche ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Primary Total Knee Arthroplasty ◽  
Medical Complications ◽  
Administrative Claims ◽  
Readmission Rates ◽  
Costs Of Care ◽  
Lengths Of Stay ◽  
Total Knee ◽  
The Impact

AbstractThe impact of gender on total knee arthroplasty (TKA) postoperative complications, readmission rates, and costs of care has not been often evaluated. Therefore, the purpose of this study was to investigate which sex had higher rates of: (1) medical complications; (2) implant complications; (3) lengths of stay (LOSs); (4) readmission rates; and (5) costs after TKA. A query was performed using an administrative claims database from January 1, 2005, to March 31, 2015. Patients who had TKAs were identified using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Males and females were filtered separately and matched according to age and various medical comorbidities leading to 1,590,626 patients equally distributed. Primary outcomes analyzed included 90-day medical complications, LOSs, 90-day readmission rates, in addition to day of surgery and total global 90-day episode of care costs. Pearson's chi-square analyses were used to compare medical complications and readmission rates. Welch's t-tests were used to test for significance in matching outcomes and costs. A p-value of less than 0.01 was considered statistically significant. Males had a smaller risk of complications than women (1.35 vs. 1.40%, p < 0.006) and higher rates of implant-related complications (2.28 vs. 1.99%, p < 0.0001). Mean LOSs were lower for males: 3.16 versus 3.34 days (p < 0.0001). The 90-day readmission rates were higher in men (9.67 vs. 8.12%, p < 0.0001). This study demonstrated that males undergoing primary TKA have lower medical complications and shorter LOSs then their female counterparts. However, males have higher implant-related complications, readmission rates, and costs of care.

scholarly journals Addiction Medicine Consultations Reduce Readmission Rates for Patients With Serious Infections From Opioid Use Disorder

2018 ◽  
Vol 68 (11) ◽  
pp. 1935-1937 ◽  
Author(s):  
Laura R Marks ◽  
Satish Munigala ◽  
David K Warren ◽  
Stephen Y Liang ◽  
Evan S Schwarz ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Use ◽  
Addiction Medicine ◽  
Readmission Rates ◽  
Serious Infections

scholarly journals 213. A Comparison of Medication Assisted Therapy Treatment Strategies for Opioid Use Disorder in Persons who Inject Drugs and are Hospitalized with Serious Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S126-S126
Author(s):  
Laura Marks ◽  
Evan Schwarz ◽  
David Liss ◽  
Munigala Satish ◽  
David K Warren ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Hospital Readmissions ◽  
Treatment Strategies ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Readmission Rates ◽  
Persons Who Inject Drugs ◽  
Increased Risk ◽  
Hospital Patients ◽  
The Impact

Abstract Background Persons who inject drugs (PWID) with opioid use disorder (OUD) are at increased risk of invasive bacterial and fungal infections, which warrant prolonged, inpatient parenteral antimicrobial therapy. Such admissions are complicated by opioid cravings and withdrawal. Comparisons of medications for OUD during prolonged admissions for these patients have not been previously reported. The aim of this study was to evaluate the impact of different OUD treatment strategies in this population, and their impact on ED and hospital readmissions. Methods We retrospectively analyzed consecutive admissions for invasive bacterial or fungal infections in PWID, admitted between January 2016 and January 2019 at Barnes-Jewish Hospital. Patients in our cohort were required to receive an infectious diseases consult, and an anticipated antibiotic treatment duration of >2 weeks. We collected data on demographics, comorbidities, length of stay, microbiologic data, medications prescribed for OUD, mortality, and readmission rates. We compared 90-day readmission rates by OUD treatment strategies using Kaplan–Meier curves. Results In our cohort of 237 patients, treatment of OUD was buprenorphine (17.5%), methadone (25.3%), or none (56.2%). Among patients receiving OUD treatment, 30% had methadone tapers and/or methadone discontinued upon discharge. Patient demographics were similar for each OUD treatment strategy. Infection with HIV (2.8%), and hepatitis B (3%), and hepatitis C (67%) were similar between groups. Continuation of medications for OUD was associated with increased completion of parenteral antibiotics (odds ratio 2.11; 95% confidence interval 1.70–2.63). When comparing medications for OUD strategies, methadone had the lowest readmission rates, followed by buprenorphine, and no treatment (P = 0.0013) (figure). Discontinuation of methadone during the admission or upon discharge was associated with the highest readmission rates. Conclusion Continuation of OUD treatment without tapering, was associated with improved completion of parenteral antimicrobials in PWID with invasive bacterial or fungal infections lower readmission rates. Tapering OUD treatment during admission was associated with higher readmission rates. Disclosures All authors: No reported disclosures.

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