Cost and Quality Implications of Opioid-Based Postsurgical Pain Control in Total Abdominal Hysterectomy: A Study of Cost Outliers and Opioid-Related Adverse Events

Objective A retrospective medical record review, case-control study of patients undergoing total abdominal hysterectomy was conducted to determine the relationship between opioid burden, related adverse drug effects (ADEs), and extended length of stay (LOS) and acute care costs cause(s) of LOS outliers. Methods Ninety-seven case patients with extended LOS (≥ 5 days) met the study eligibility criteria and were matched with case controls (patients with a LOS <5 days). The medical records of cases and controls were reviewed to collect information describing pre-established data points: opioid doses and opioid-related ADEs. Difference between cases and controls were compared using McNemar's test for matched pairs, paired t test, and signed rank test. Results Comparisons of opioid-related ADEs revealed the following statistically significant differences compared with controls: respiratory ADEs (eg, hypoxia) in 12% of cases versus 1% of controls ( P < .01) and gastrointestinal ADEs (eg, nausea/vomiting) in 44% of cases versus 19% of controls ( P < .01). Cases received higher doses during the 72 hours following postanesthesia care unit (PACU) discharge ( P = .04). By hospital discharge, cases had received 2.5 times the total opioid dose of controls and, on average, remained hospitalized 132 hours (5.5 days) longer than controls. Approximately 33% of LOS difference between cases and controls occurred prior to operating room admission, whereas approximately 66% occurred between PACU admission and hospital discharge. Conclusions Case patients with unusually long length of hospital stay (LOS outliers) received higher opioid doses and experienced more opioid-related ADEs than controls. These factors appear to contribute to outlier status but cannot completely explain all LOS outliers.