Postsurgical Hospital Return Among Patients on Long-Term Opioid Therapy: A Comparison of Insurance Status
Limi Sharif BS,1,2 Vidhya Gunaseelan MBA, MS, MHA,2,3 Jennifer Waljee MD MPH MS,2,4 Mark Bicket MD PhD,2,3,5,6 Michael Englesbe MD,2,4 Chad Brummett MD2,3
1 Univerity of Michigan Medical School
2 Michigan Opioid Prescribing Engagement Network (OPEN), Ann Arbor, MI
3 Department of Anesthesiology, Michigan Medicine, Ann Arbor, MI
4 Department of Surgery, Michigan Medicine, Ann Arbor, MI
5 Institute for Healthcare Innovation and Policy, Ann Arbor, MI
6 School of Public Health, University of Michigan, Ann Arbor, MI
BACKGROUND
• Patients on long-term opioid therapy prior to surgery face higher postoperative healthcare costs, longer hospital lengths of stay, and complications following surgery compared to those who are opioid-naïve.(1)
• The implications of insurance type on surgical outcomes in this population are unclear.
• This study aimed to examine whether patients with Medicaid insurance faced increased rates of hospital return following surgery compared to patients with private insurance.
METHODS
•Retrospective cohort study
•Patients identified using the Michigan Surgical Quality Collaborative database (Blue Cross Blue Shield database of surgical outcomes across 69 hospitals)
•Combined with data from Michigan’s prescription drug monitoring program
•Primary outcome: Hospital Return (An ED visit or readmission within 30 days of discharge from surgery)
• Multivariable logistic regression and average marginal effect
Inclusions:
•Medicaid or private insurance
•18-64 years old
•On long-term opioid therapy (>120 total days of opioids supplied or ≥ 10 prescriptions in the year prior to surgery)2
•Surgery between Nov 2016-Feb 2021
Exclusions:
•Postoperative complications(3,4)
•Patients on buprenorphine for treatment of opioid use disorder
RESULTS
Average Marginal Effect: The risk of postoperative hospital return was 4.5 percentage points higher among patients with Medicaid insurance compared to patients with private insurance (95% CI: 0.5%, 8.4%).
Average Marginal Effect: The risk of an ED visit was 5.2 percentage points higher among patients with Medicaid insurance compared to patients with private insurance (95% CI: 1.6%, 8.8%).
CONCLUSIONS
•These data highlight disparities related to insurance coverage in patients on long-term opioid therapy.
•This may suggest differential access to healthcare resources in the postoperative period.
•Given that patients on long-term opioids are a vulnerable population, this emphasizes the need for further research on the intersection of long-term opioid therapy and insurance status in the postsurgical population and provides opportunities for future policy interventions.
REFERENCES
1.Cron DC, Englesbe MJ, Bolton CJ, et al. Preoperative Opioid Use is Independently Associated With Increased Costs and Worse Outcomes After Major Abdominal Surgery. Ann Surg. 2017;265(4):695-701. doi:10.1097/SLA.0000000000001901
2.Sun EC, Darnall BD, Baker LC, Mackey S. Incidence of and Risk Factors for Chronic Opioid Use Among Opioid-Naive Patients in the Postoperative Period. JAMA Intern Med. 2016;176(9):1286-1293. doi:10.1001/jamainternmed.2016.3298
3.Kassin MT, Owen RM, Perez S, et al. Risk Factors for 30-Day Hospital Readmission among General Surgery Patients. J Am Coll Surg. 2012;215(3):322-330. doi:10.1016/j.jamcollsurg.2012.05.024
4.Wood T, Aarts MA, Okrainec A, et al. Emergency Room Visits and Readmissions Following Implementation of an Enhanced Recovery After Surgery (iERAS) Program. J Gastrointest Surg. 2018;22(2):259-266. doi:10.1007/s11605-017-3555-2
