Trend and Economic Burden of Intravenous Narcotic Analgesic Utilization in Abdominal Aortic Aneurysm Repair in the United States
Besma J. Nejim, MBChB, MPH1, Widian Alshwaily, MD2, Muhammad Fateeh, MD1, Satinderjit Locham, MD1, Hanaa Dakour Aridi, MD1, Mahmoud Malas, MD, MHS2.
1Johns Hopkins University School of Medicine, Baltimore, MD, USA, 2Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.
Objectives: Opioid-based narcotics have been implicated with adverse postoperative outcomes, such as paralytic ileus and respiratory complications. Yet the use of IV narcotic analgesics (IVNA) within the context of abdominal aortic aneurysm (AAA) repair was not fully described. We sought to evaluate the trend and the economic burden of IV narcotic use in open Aortic (OAR) and endovascular (EVAR) AAA repair.
Methods: the Premier database (2009-2015) was inquired. Patients undergoing OAR and EVAR for a primary diagnosis of non-ruptured AAA were identified via ICD-9-CM codes. IVNA and IV non-narcotic analgesics (IVNNA) use was assessed. Generalized linear modeling was used to estimate the hospitalization cost. Logistic regression analysis was implemented to report the prolonged length of in-hospital stay pLOS (LOS>75th centile) and in-hospital mortality
Results: A total of 40,026 patients were included [EVAR: 33,625(84.0%)]. Analgesic use was more common in OAR, IVNA (96.5%vs.91.4%), IVNNA (22.9%vs.9.5%) (Both P<.001). The practice trend of IVNA administration after OAR was constant, but decreasing after EVAR. The use of IVNNA was significantly increasing over the study period (P-for-trend<.001). IVNA increased the cost of OAR by $5,966 [predicted mean difference(95%CI): $5,966($3,334-$8,599); P<.001] and the cost of EVAR by $1,413[predicted mean difference(95%CI): $1,413($671-$2,154); P<.001]. Interestingly, IVNNA was not associated with significant increase in hospitalization cost of OR but it was associated with slightly higher cost if used during EVAR adjusting for patientís comorbidities, hospital characteristics and postoperative complications (Figure). IVNA independently increased the odds of pLOS in OAR [aOR(95%CI): 1.35(1.05-2.24); P=.026]and in EVAR [aOR(95%CI): 1.34(1.21-1.49); P<.001]. IVNNA didnít increase the LOS in OAR but slightly increased LOS in EVAR [aOR(95%CI): 1.26(1.15-1.38);P≤.001]. While
IVNA didnít affect the in-hospital mortality, IVNNA use was associated with survival benefit in OAR [aOR(95%CI): 0.66(0.46-0.94); P=.023].
Conclusions: Despite the emergence and the benefit of potent non-opioid based analgesics, the trend of opioid analgesics utilization in non-ruptured AAA open repair seems constant. Intravenous narcotic utilization was associated with higher cost and longer in-hospital stay, while the use of non-opioid was associated with survival benefit. IV narcotic utilization during AAA repair should be avoided particularly with the rise of opioid abuse epidemic in the United States.
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