The Association of Chronic Opioid Use with Resource Utilization and Outcomes after Emergency General Surgery.

INTRODUCTION: Chronic opioid use is prevalent among patients undergoing emergent surgery. We sought to understand it on the outcomes of the most common emergency surgery procedures, Appendectomy and Cholecystectomy. METHODS: We used the National Inpatient Sample to identify chronic opioid use in emergency appendectomies (n = 953) and cholecystectomies (n = 2826) from 2005 to 2014. Primary outcome was length of stay (LOS), and secondary outcomes included total charges and mortality. LOS was analyzed with multivariate Poisson regression, total charges with multivariate linear regression. RESULTS: For Appendectomy, the opioid abuse group was younger, had similar gender and racial demographics, had more Medicaid and private insurance and less self-pay, and had no clinically significant differences in comorbidities. Those with chronic opioid use had a 24% increased LOS (20-29%, p < .001) and $5532(±$881, p < .001) higher hospital charges. Mortality was very rare and not different (0.2% vs 0.6%, aOR 0.54 [0.11-2.58], p = .44). For Cholecystectomy, the opioid abuse group was similar in age and gender, had slightly more white individuals, had a slightly different payor mix including higher rate of private insurance, and had no clinically significant differences in comorbidities. Patients with preoperative chronic opioid abuse showed a 14% increased LOS (12-16%, p < .001) and $5352 (± $1065, p < .001) higher hospital charges, but no significant increase in mortality (0.7% vs 0.6%, aOR 1.58 [0.77-3.25], p = .22). CONCLUSION: Patients with chronic opioid abuse did not have increased mortality following EGS but had increased resource utilization and LOS. These findings may help explore the impact of opioid abuse on hospital and societal cost.

Outcomes of Ventral Hernia Repair in Solid Organ Transplant Patients: A Regression Analysis of the National Inpatient Sample.

BACKGROUND: Solid organ transplant has been identified as an independent risk factor in ventral hernia repair. Previous studies have generally focused on case studies or small samples. We sought to investigate the impact of liver or kidney transplant on ventral hernia repair outcomes using a nationally representative sample. METHODS: The National Inpatient Sample was used to identify ventral hernia repairs from years 2005 to 2014. We then divided them into two groups, patients with prior solid organ transplant and those without, and used logistic regression to analyze the effect of this variable on outcomes. We then investigated the relationship between various comorbidities and 30-d outcomes of surgery in both groups after adjusting for comorbidities. The primary outcome we looked at was mortality, with secondary outcomes such as length of stay and various surgical complications. RESULTS: We compared two groups consisting of patients with prior transplant (n = 3317) and patients without (n = 372,775) and found that patients with prior liver or kidney transplant did not have higher mortality rates and also did not have longer lengths of stay. In addition, in terms of preoperative variables, patients with transplant were more likely to have the following comorbidities: cardiac arrhythmia, chronic blood loss anemia, chronic pulmonary disease, congestive heart failure, depression, metastatic cancer, obesity, psychoses, solid tumor without metastasis, and weight loss. Diabetes was associated with higher mortality in transplant patients. CONCLUSIONS: Patients without prior liver or kidney transplant did not have higher mortality rates or lengths of stay.