214. Readmissions, Morbidity and Early Mortality Among Chronic Opioid Users Who Receive Lobectomy for Non-Small Cell Lung Cancer
David B. Nelson, Jiangong Niu, Kyle G. Mitchell, *Ara A. Vaporciyan, *Wayne L. Hofstetter, Mara B. Antonoff, Sharon H. Giordano, Boris Sepesi, *Reza J. Mehran, *David C. Rice
MD Anderson Cancer Center, Houston, TX
Invited Discussant: *Michael J. Liptay
Objective: The opioid crisis has led to an increased likelihood of identifying preexisting opioid use in the general population. We sought to identify whether chronic opioid users are at an increased risk of complications or readmission following lobectomy for non-small cell lung cancer (NSCLC).
Methods: The SEER-Medicare linked database was queried to identify patients over the age of 65 who received a lobectomy for NSCLC. Preoperative opioid usage was identified through Part D records. Chronic opioid users were those with at least 120 cumulative days of opioid supply between 31 days to 12 months prior to surgery. Naïve users were those with no opioid supply during this time frame, and intermittent users had less than 120 days of cumulative opioid supply. 1:2 propensity matching was performed between chronic and intermittent/naïve users based on demographic, comorbidity, tumor and treatment variables. Multivariable logistic regression was used to determine predictors of 90-day readmission.
Results: 2,724 matched pairs were identified. In-hospital morbidity was not higher among chronic opioid users (Table). However, 30-day mortality and 90-day mortality were substantially higher among chronic opioid users as compared with naïve or intermittent opioid users. Readmissions within 90-days were increased among chronic opioid users. Readmissions relating to hematologic, neurologic, gastrointestinal, and wound complications were not different according to opioid use, however, there was an increase in readmissions relating to pulmonary, renal, infectious, cardiac, and electrolyte causes among chronic opioid users. Independent predictors of decreased 90-day readmission include naïve (OR 0.58, 95% CI 0.47 - 0.72) or intermittent (OR 0.79, 95% CI 0.62 - 0.99) opioid use, female sex (OR 0.71, 95% CI 0.59 - 0.87), rural environment, and receipt of video assisted thoracoscopic surgery (OR 0.75, 95% CI 0.61 - 0.92). Increased 90-day readmission was also observed among those with poorly differentiated tumors, higher Charlson scores, who are unmarried, and who reside in a zip code with less high school graduates.
Conclusions: Patients who chronically use opioids prior to lobectomy represent high risk patients. The risk of 30-day mortality, 90-day mortality, and 90-day readmission is substantially elevated. Efforts to optimize readiness for discharge and close outpatient follow-up should be investigated to reduce readmission burden among this population.