Trends and Outcomes of Cardiovascular Surgery in Patients with Opioid Use Disorders

Krish C. Dewan, Karan S. Dewan, Jay J. Idrees, Suparna M. Navale, Brad F. Rosinski, Lars G. Svensson, A. Marc Gillinov, Douglas R. Johnston, Faisal Bakaeen, Edward G. Soltesz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

27 Scopus citations


Importance: Persistent opioid use is currently a major health care crisis. There is a lack of knowledge regarding its prevalence and effect among patients undergoing cardiac surgery. Objective: To characterize the national population of cardiac surgery patients with opioid use disorder (OUD) and compare outcomes with the cardiac surgery population without OUD. Design, Setting, and Participants: In this retrospective population-based cohort study, more than 5.7 million adult patients who underwent cardiac surgery (ie, coronary artery bypass graft, valve surgery, or aortic surgery) in the United States were included. Pregnant patients were excluded. Propensity matching was performed to compare outcomes between cardiac surgery patients with OUD (n = 11359) and without OUD (n = 5707193). The Nationwide Inpatient Sample database was queried from January 1998 to December 2013. Data were analyzed in January 2018. Exposures: Persistent opioid use and/or dependence. Main Outcomes and Measures: In-hospital mortality, complications, length of stay, costs, and discharge disposition. Results: Among the 5718552 included patients, 3887097 (68.0%) were male; the mean (SD) age of patients with OUD was 47.67 (13.03) years and of patients without OUD was 65.53 (26.14) years. The prevalence of OUD among cardiac surgery patients was 0.2% (n = 11359), with an 8-fold increase over 15 years (0.06% [262 of 437641] in 1998 vs 0.54% [1425 of 263930] in 2013; difference, 0.48%; 95% CI of difference, 0.45-0.51; P <.001). Compared with patients without OUD, patients with OUD were younger (mean [SD] age, 48 [0.30] years vs 66 [0.05] years; P <.001) and more often male (70.8% vs 68.0%; P <.001), black (13.7% vs 4.8%), or Hispanic (9.1% vs 4.8%). Patients with OUD more commonly fell in the first quartile of median income (30.7% vs 17.1%; P <.001) and were more likely to be uninsured or Medicaid beneficiaries (48.6% vs 7.7%; P <.001). Valve and aortic operations were more commonly performed among patients with OUD (49.8% vs 16.4%; P <.001). Among propensity-matched pairs, the mortality was similar between patients with vs without OUD (3.1% vs 4.0%; P =.12), but cardiac surgery patients with OUD had an overall higher incidence of major complications (67.6% vs 59.2%; P <.001). Specifically, the risks of blood transfusion (30.4% vs 25.9%; P =.002), pulmonary embolism (7.3% vs 3.8%; P <.001), mechanical ventilation (18.4% vs 15.7%; P =.02), and prolonged postoperative pain (2.0% vs 1.2%; P =.048) were significantly higher. Patients with OUD also had a significantly longer length of stay (median [SE], 11 [0.30] vs 10 [0.22] days; P <.001) and cost significantly more per patient (median [SE], 49790 [1059] vs 45216 [732]; P <.001). Conclusions and Relevance: The population of patients with persistent opioid use or opioid dependency undergoing cardiac surgery has increased over the past decade. Cardiac surgery in patients with OUD is safe but is associated with higher complications and cost. Patients should not be denied surgery because of OUD status but should be carefully monitored postoperatively for complications.

Original languageEnglish (US)
Pages (from-to)232-240
Number of pages9
JournalJAMA surgery
Issue number3
StatePublished - Mar 2019

ASJC Scopus subject areas

  • Surgery


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