Trends, outcomes, and factors associated with in-hospital opioid overdose following major surgery

With the growing opioid epidemic across the US, in-hospital utilization of opioids has garnered increasing attention. Using a national cohort, this study sought to characterize trends, outcomes, and factors associated with in-hospital opioid overdose (OD) following major elective operations. We identified all adult (≥18 years) hospitalizations entailing select elective procedures in the 2016–2020 National Inpatient Sample. Patients who experienced in-hospital opioid overdose were characterized as OD (others: Non-OD). The primary outcome of interest was in-hospital OD. Multivariable logistic and linear regression models were developed to evaluate the association between in-hospital OD and mortality, length of stay (LOS), hospitalization costs, and non-home discharge. Of an estimated 11, 096, 064 hospitalizations meeting study criteria, 5375 (0. 05 %) experienced a perioperative OD. Compared to others, OD were older (66 57–73 vs 64 54–72 years, p < 0. 001), more commonly female (66. 3 vs 56. 7 %, p < 0. 001), and in the lowest income quartile (26. 4 vs 23. 2 %, p < 0. 001). After adjustment, female sex (Adjusted Odds Ratio AOR 1. 68, 95 % Confidence Interval CI 1. 47–1. 91, p < 0. 001), White race (AOR 1. 19, CI 1. 01–1. 42, p = 0. 04), and history of substance use disorder (AOR 2. 51, CI 1. 87–3. 37, p < 0. 001) were associated with greater likelihood of OD. Finally, OD was associated with increased LOS (β +1. 91 days, CI 1. 60–2. 21, p < 0. 001), hospitalization costs (β +7500, CI 5900–9100, p < 0. 001), and greater odds of non-home discharge (AOR 2. 00, CI 1. 61–2. 48, p < 0. 001). Perioperative OD remains a rare but costly complication after elective surgery. While pain control remains a priority postoperatively, protocols and recovery pathways must be re-examined to ensure patient safety.