Perioperative outcomes among chronic opioid users who receive lobectomy for non-small cell lung cancer
Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved..
OBJECTIVE: We sought to identify whether chronic opioid users are at increased risk for complications or hospital readmission following lobectomy for non-small cell lung cancer.
METHODS: The National Cancer Institute Surveillance, Epidemiology, and End Results-Medicare database was queried to identify patients older than age 65 years who received a lobectomy for non-small cell lung cancer. Chronic opioid users were identified through Medicare Part D records and were defined as those with >120 cumulative days of opioid supply for the year before surgery. A systematic 1:2 propensity matching was performed among chronic opioid users.
RESULTS: Six thousand four hundred thirty-seven patients were identified, among whom 3627 (56%) were opioid naïve, 1866 (29%) were intermittent opioid users, and 944 (15%) were chronic opioid users. After propensity matching, 30-day mortality and 90-day mortality were nearly 2-fold higher among chronic opioid users compared with nonchronic users. In addition, length of stay and hospital charges were increased among chronic opioid users (median, 6 vs 7 days and mean increase, $12,526, respectively). Multivariable analysis revealed that intermittent opioid users and chronic opioid users were associated with an increased risk of 90-day hospital readmission compared with opioid-naïve patients (odds ratio, 1.35; 95% confidence interval, 1.07-1.71 and odds ratio, 1.72; 95% confidence interval, 1.40-2.12, respectively), predominantly burdened by infectious, renal, and pulmonary causes.
CONCLUSIONS: Patients who chronically use opioids before lobectomy represent high-risk patients. The risk of 30- and 90-day mortality, length of stay, hospital charges, and 90-day readmission after lobectomy among chronic opioid users are substantially elevated.
| Errataetall: |
CommentIn: J Thorac Cardiovasc Surg. 2020 Feb;159(2):703-704. - PMID 31813537 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2020 |
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| Erschienen: |
2020 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:159 |
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| Enthalten in: |
The Journal of thoracic and cardiovascular surgery - 159(2020), 2 vom: 30. Feb., Seite 691-702.e5 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Nelson, David B [VerfasserIn] |
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| Links: |
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| Themen: |
Journal Article |
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| Anmerkungen: |
Date Completed 11.11.2020 Date Revised 11.11.2020 published: Print-Electronic CommentIn: J Thorac Cardiovasc Surg. 2020 Feb;159(2):703-704. - PMID 31813537 Citation Status MEDLINE |
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| doi: |
10.1016/j.jtcvs.2019.09.059 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM315736712 |
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| 100 | 1 | |a Nelson, David B |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Perioperative outcomes among chronic opioid users who receive lobectomy for non-small cell lung cancer |
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| 500 | |a Date Completed 11.11.2020 | ||
| 500 | |a Date Revised 11.11.2020 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: J Thorac Cardiovasc Surg. 2020 Feb;159(2):703-704. - PMID 31813537 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved. | ||
| 520 | |a OBJECTIVE: We sought to identify whether chronic opioid users are at increased risk for complications or hospital readmission following lobectomy for non-small cell lung cancer | ||
| 520 | |a METHODS: The National Cancer Institute Surveillance, Epidemiology, and End Results-Medicare database was queried to identify patients older than age 65 years who received a lobectomy for non-small cell lung cancer. Chronic opioid users were identified through Medicare Part D records and were defined as those with >120 cumulative days of opioid supply for the year before surgery. A systematic 1:2 propensity matching was performed among chronic opioid users | ||
| 520 | |a RESULTS: Six thousand four hundred thirty-seven patients were identified, among whom 3627 (56%) were opioid naïve, 1866 (29%) were intermittent opioid users, and 944 (15%) were chronic opioid users. After propensity matching, 30-day mortality and 90-day mortality were nearly 2-fold higher among chronic opioid users compared with nonchronic users. In addition, length of stay and hospital charges were increased among chronic opioid users (median, 6 vs 7 days and mean increase, $12,526, respectively). Multivariable analysis revealed that intermittent opioid users and chronic opioid users were associated with an increased risk of 90-day hospital readmission compared with opioid-naïve patients (odds ratio, 1.35; 95% confidence interval, 1.07-1.71 and odds ratio, 1.72; 95% confidence interval, 1.40-2.12, respectively), predominantly burdened by infectious, renal, and pulmonary causes | ||
| 520 | |a CONCLUSIONS: Patients who chronically use opioids before lobectomy represent high-risk patients. The risk of 30- and 90-day mortality, length of stay, hospital charges, and 90-day readmission after lobectomy among chronic opioid users are substantially elevated | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a lobectomy | |
| 650 | 4 | |a lung cancer | |
| 650 | 4 | |a opioid dependency | |
| 650 | 4 | |a perioperative morbidity | |
| 700 | 1 | |a Niu, Jiangong |e verfasserin |4 aut | |
| 700 | 1 | |a Mitchell, Kyle G |e verfasserin |4 aut | |
| 700 | 1 | |a Antonoff, Mara B |e verfasserin |4 aut | |
| 700 | 1 | |a Giordano, Sharon H |e verfasserin |4 aut | |
| 700 | 1 | |a Hofstetter, Wayne L |e verfasserin |4 aut | |
| 700 | 1 | |a Vaporciyan, Ara A |e verfasserin |4 aut | |
| 700 | 1 | |a Sepesi, Boris |e verfasserin |4 aut | |
| 700 | 1 | |a Mehran, Reza J |e verfasserin |4 aut | |
| 700 | 1 | |a Rice, David C |e verfasserin |4 aut | |
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