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Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events

BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility...

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Autores principales: Minkowitz, Harold S., Scranton, Richard, Gruschkus, Stephen K., Nipper-Johnson, Kathy, Menditto, Laura, Dandappanavar, Akash
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Academy of Managed Care Pharmacy 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10438184/
https://www.ncbi.nlm.nih.gov/pubmed/25166294
http://dx.doi.org/10.18553/jmcp.2014.20.9.948
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author Minkowitz, Harold S.
Scranton, Richard
Gruschkus, Stephen K.
Nipper-Johnson, Kathy
Menditto, Laura
Dandappanavar, Akash
author_facet Minkowitz, Harold S.
Scranton, Richard
Gruschkus, Stephen K.
Nipper-Johnson, Kathy
Menditto, Laura
Dandappanavar, Akash
author_sort Minkowitz, Harold S.
collection PubMed
description BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility of a risk-scoring model in categorizing patients at high risk of experiencing ORADEs; and (c) quantify potential clinical/economic benefits of targeting high-risk GI surgical patients for opioid-sparing regimens in terms of hospitalization cost, length of stay (LOS), and 30-day readmission rates. METHODS: Using a retrospective design based on an administrative database, patients with an inpatient surgical procedure between January 1, 2010, and December 31, 2010, were included. GI surgical patients aged greater than 18 years followed from admission through 30 days postdischarge were characterized as high or low risk using clinical/demographic characteristics and were evaluated for several outcomes. Using multivariate logistic regression, the ORADE incidence, total hospitalization cost, LOS, and 30-day readmissions were compared for high-risk and low-risk patients. RESULTS: In 87.8% (n = 3,235) of the surgical population, there was a strong concordance between risk assignment and ORADE incidence. Among the remaining 12.2% (n = 449) of patients, 5.5% (n = 202) were low risk with an ORADE, and 6.7% (n = 247) were high risk without an ORADE. Overall, 20.6% (n = 344) of high-risk patients experienced ≥ 1 ORADE (mean cost: $31,988; LOS: 12.1 days) compared with only 5.3% (n = 107) of low-risk patients (mean cost: $25,216; LOS: 8.0 days). High-risk patients had higher hospitalization costs and longer LOS than low-risk patients, respectively (mean cost: $19,234 vs. $13,036; mean LOS: 6.8 days vs. 3.3 days). These differences correspond to 47.0% higher costs for high-risk patients and an LOS approximately twice as long compared with low-risk patients. CONCLUSIONS: Patient clinical/demographic characteristics influence the risk of developing ORADEs. Risk assessment tools can effectively identify high-risk patients, thereby enabling interventions that can reduce ORADEs, decrease hospital costs, and improve postsurgical experiences for patients.
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spelling pubmed-104381842023-08-21 Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events Minkowitz, Harold S. Scranton, Richard Gruschkus, Stephen K. Nipper-Johnson, Kathy Menditto, Laura Dandappanavar, Akash J Manag Care Pharm Research BACKGROUND: Opioid-related adverse drug events (ORADEs) are common causes of hospitalization and increased health care costs. OBJECTIVES: To (a) estimate rates of specific adverse drug events (ADEs) among gastrointestinal (GI) surgery patients receiving postoperative opioids; (b) examine the utility of a risk-scoring model in categorizing patients at high risk of experiencing ORADEs; and (c) quantify potential clinical/economic benefits of targeting high-risk GI surgical patients for opioid-sparing regimens in terms of hospitalization cost, length of stay (LOS), and 30-day readmission rates. METHODS: Using a retrospective design based on an administrative database, patients with an inpatient surgical procedure between January 1, 2010, and December 31, 2010, were included. GI surgical patients aged greater than 18 years followed from admission through 30 days postdischarge were characterized as high or low risk using clinical/demographic characteristics and were evaluated for several outcomes. Using multivariate logistic regression, the ORADE incidence, total hospitalization cost, LOS, and 30-day readmissions were compared for high-risk and low-risk patients. RESULTS: In 87.8% (n = 3,235) of the surgical population, there was a strong concordance between risk assignment and ORADE incidence. Among the remaining 12.2% (n = 449) of patients, 5.5% (n = 202) were low risk with an ORADE, and 6.7% (n = 247) were high risk without an ORADE. Overall, 20.6% (n = 344) of high-risk patients experienced ≥ 1 ORADE (mean cost: $31,988; LOS: 12.1 days) compared with only 5.3% (n = 107) of low-risk patients (mean cost: $25,216; LOS: 8.0 days). High-risk patients had higher hospitalization costs and longer LOS than low-risk patients, respectively (mean cost: $19,234 vs. $13,036; mean LOS: 6.8 days vs. 3.3 days). These differences correspond to 47.0% higher costs for high-risk patients and an LOS approximately twice as long compared with low-risk patients. CONCLUSIONS: Patient clinical/demographic characteristics influence the risk of developing ORADEs. Risk assessment tools can effectively identify high-risk patients, thereby enabling interventions that can reduce ORADEs, decrease hospital costs, and improve postsurgical experiences for patients. Academy of Managed Care Pharmacy 2014-09 /pmc/articles/PMC10438184/ /pubmed/25166294 http://dx.doi.org/10.18553/jmcp.2014.20.9.948 Text en Copyright © 2014, Academy of Managed Care Pharmacy. All rights reserved. https://creativecommons.org/licenses/by/4.0/This article is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use and redistribution provided that the original author and source are credited.
spellingShingle Research
Minkowitz, Harold S.
Scranton, Richard
Gruschkus, Stephen K.
Nipper-Johnson, Kathy
Menditto, Laura
Dandappanavar, Akash
Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events
title Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events
title_full Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events
title_fullStr Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events
title_full_unstemmed Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events
title_short Development and Validation of a Risk Score to Identify Patients at High Risk for Opioid-Related Adverse Drug Events
title_sort development and validation of a risk score to identify patients at high risk for opioid-related adverse drug events
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10438184/
https://www.ncbi.nlm.nih.gov/pubmed/25166294
http://dx.doi.org/10.18553/jmcp.2014.20.9.948
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