Potential disease burden of patients with substance abuse undergoing major abdominal surgery: A propensity score-matched analysis

Abstract

Background: Over 19 million Americans have a substance abuse disorder. The current study sought to characterize the relationship between substance abuse with in-hospital outcomes following major, elective abdominal surgery.

Methods: The Nationwide Inpatient Sample was used to identify patients who underwent major abdominal surgery between 2007 to 2014. Patients with preoperative substance abuse, including alcohol, opioids, and non-opioid drugs, were identified. Propensity score matching was used to examine the association of substance abuse with perioperative outcomes.

Results: Among 301,659 patients, 7,925 patients (2.6%) had a history of substance abuse. Pancreatectomy was the surgical procedure with the highest proportion of patients with substance abuse history (n = 844, 4.7%). Compared with patients without a substance abuse history, patients with a substance abuse history were more likely to be younger (median age, 60 years [interquartile range (IQR) 52-69] vs 63 years [IQR 52-72]), male (n = 5,438, 67.5% vs n = 132,961, 54.7%), and be in the lowest income category (n = 2,062, 26% vs n = 64,345, 21.9%) (all P < .001). On propensity score matching, substance abuse was associated with increased odds ratio of experiencing a complication (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.55-1.82), non-home discharge (OR 1.95, 95% CI 1.76-2.16), extended length of stay (OR 1.88, 95% CI 1.76-2.02), and higher expenditure (OR 1.62, 95% CI 1.49-1.77). Stratified by the type of substance abuse, patients with history of alcohol (OR 1.57, 95% CI 1.44-1.71) and drug abuse (OR 1.26, 95% CI 1.14-1.39) were more likely to experience a complication, whereas only history of alcohol abuse was associated with higher odds ratio of in-hospital mortality (OR 1.38, 95% CI 1.07-1.79) (all P < .05).

Conclusion: Up to 1 in 50 patients undergoing complex abdominal surgery had a substance abuse history. History of substance abuse was associated with an increased risk of adverse perioperative outcomes and higher healthcare expenditures.