Association of substance-use disorder with outcomes of major elective abdominal operations: A contemporary national analysis

Baran Khoraminejad; Sara Sakowitz, MS MPH; Zihan Gao, MHSc; Nikhil Chervu, MD; Joanna Curry, BA; Konmal Ali; Syed Shahyan Bakhtiyar, MD MBE; Peyman Benharash, MD MS

Surgery Open Science (Jun 2024)

Association of substance-use disorder with outcomes of major elective abdominal operations: A contemporary national analysis

Baran Khoraminejad,
Sara Sakowitz, MS MPH,
Zihan Gao, MHSc,
Nikhil Chervu, MD,
Joanna Curry, BA,
Konmal Ali,
Syed Shahyan Bakhtiyar, MD MBE,
Peyman Benharash, MD MS

Affiliations

Baran Khoraminejad: CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America; Boston University, Boston, MA, United States of America
Sara Sakowitz, MS MPH: CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
Zihan Gao, MHSc: CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
Nikhil Chervu, MD: CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America; Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
Joanna Curry, BA: CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
Konmal Ali: CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America
Syed Shahyan Bakhtiyar, MD MBE: CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America; Department of Surgery, University of Colorado, Denver, Aurora, CO, United States of America
Peyman Benharash, MD MS: CORELAB, Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America; Department of Surgery, University of California, Los Angeles, Los Angeles, CA, United States of America; Corresponding author at: 10833 Le Conte Avenue, UCLA Center for Health Sciences, Room 62-249, Los Angeles, CA 90095, United States of America.

Journal volume & issue: Vol. 19
pp. 44 – 49

Abstract

Read online

Background: Affecting >20million people in the U.S., including 4 % of all hospitalized patients, substance use disorder (SUD) represents a growing public health crisis. Evaluating a national cohort, we aimed to characterize the association of concurrent SUD with perioperative outcomes and resource utilization following elective abdominal operations. Methods: All adult hospitalizations entailing elective colectomy, gastrectomy, esophagectomy, hepatectomy, and pancreatectomy were tabulated from the 2016–2020 National Inpatient Sample. Patients with concurrent substance use disorder, comprising alcohol, opioid, marijuana, sedative, cocaine, inhalant, hallucinogen, or other psychoactive/stimulant use, were considered the SUD cohort (others: nSUD). Multivariable regression models were constructed to evaluate the independent association between SUD and key outcomes. Results: Of ∼1,088,145 patients, 32,865 (3.0 %) comprised the SUD cohort. On average, SUD patients were younger, more commonly male, of lowest quartile income, and of Black race. SUD patients less frequently underwent colectomy, but more often pancreatectomy, relative to nSUD.Following risk adjustment and with nSUD as reference, SUD demonstrated similar likelihood of in-hospital mortality, but remained associated with increased odds of any perioperative complication (Adjusted Odds Ratio [AOR] 1.17, CI 1.09–1.25). Further, SUD was linked with incremental increases in adjusted length of stay (β + 0.90 days, CI +0.68–1.12) and costs (β + $3630, CI +2650–4610), as well as greater likelihood of non-home discharge (AOR 1.54, CI 1.40–1.70). Conclusions: Concurrent substance use disorder was associated with increased complications, resource utilization, and non-home discharge following major elective abdominal operations. Novel interventions are warranted to address increased risk among this vulnerable population and address significant disparities in postoperative outcomes.

Published in Surgery Open Science

ISSN: 2589-8450 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: https://www.journals.elsevier.com/surgery-open-science/

About the journal

Abstract

Keywords