Resource use and costs associated with opioid-induced constipation following total hip or total knee replacement surgery

Figures & data

Table 1 Patient and hospital characteristics for matched cohorts with and without OICa

	Matched cohort, N = 81,780
	All	With OIC, n=40,890	Without OIC, n=40,890	p-value
Age, years, mean (SD)	68 (11)	68 (11)	68 (11)	1.00
Sex, men	37.0	37.1	36.9	0.68
Race
Caucasian	81.5	81.3	81.6	0.50
Black	8.0	8.0	7.9
Other	10.6	10.7	10.5
Payer
Medicare	63.4	63.6	63.1	<0.001
Medicaid	3.3	3.8	2.9
Managed care	23.5	22.6	24.2
Other	9.8	10.1	9.6
Admission source
Home	98.4	98.5	98.4	0.82
Transferred from acute care facility	0.8	0.8	0.8
Transferred from skilled nursing facility	0.2	0.2	0.2
Other/unknown	0.6	0.6	0.6
Admission type
Elective	92.8	93.4	92.3	<0.001
Emergency	3.1	3.4	2.7
Trauma	0.1	0.1	0.1
Urgent	3.7	2.7	4.7
Other	0.3	0.3	0.3
Comorbidities during index encounter
Myocardial infarction	4.2	4.4	4.0	0.005
Heart failure	3.7	4.1	3.3	<0.001
Peripheral vascular disease	3.0	3.0	3.0	0.79
Cerebrovascular disease	1.1	1.1	1.0	0.15
Dementia	0.1	0.1	0.1	0.67
Chronic pulmonary disease	18.2	18.3	18.2	0.67
Rheumatologic disease	4.9	4.9	4.9	0.83
Peptic ulcer disease	0.8	0.8	0.8	0.97
Mild liver disease	0.4	0.4	0.4	0.96
Moderate-to-severe liver disease	0.0	0.0	0.0	1.00
Diabetes	19.2	19.3	19.1	0.60
Diabetes with chronic complications	1.8	2.1	1.5	<0.001
Hemiplegia or paraplegia	0.1	0.1	0.1	1.00
Renal disease	7.1	8.3	5.8	<0.001
Any malignancy	1.4	1.4	1.4	0.77
Metastatic solid tumor	0.3	0.3	0.3	0.81
AIDS/HIV	0.1	0.1	0.0	0.22
Charlson Comorbidity Index, mean (SD)	0.8 (1.2)	0.9 (1.3)	0.8 (1.1)	<0.001
Chronic pain	7.1	7.1	7.1	1.00
Hemodialysis	0.4	0.4	0.4	0.91
Use of peripheral µ-opioid receptor antagonists	0.5	1.0	0.1	<0.001
Use of selected pro-motility drugs and stool softeners	87.2	88.5	85.9	<0.001
Total oral morphine equivalents (mg) for index hospitalization, mean (SD)	129.7 (223.2)	129 (236.7)	130.3 (208.7)	0.44
Total days of opioid use, mean (SD)	3.3 (1.9)	3.5 (2.1)	3.2 (1.7)	<0.001
Hospital geographic divisions
New England	3.2	3.2	3.1	0.93
Middle Atlantic	14.8	14.7	14.8
East North Central	19.6	19.6	19.7
West North Central	8.9	8.9	8.8
South Atlantic	22.7	22.5	22.9
East South Central	9.9	9.9	9.9
West South Central	7.5	7.6	7.5
Mountain	5.5	5.5	5.4
Pacific	8.0	8.1	7.9
Hospital bed capacity
<150	11.9	12.8	11.1	<0.001
150–249	15.9	15.0	16.9
250–349	21.0	20.4	21.6
350–449	16.8	15.6	17.9
450–549	16.3	18.2	14.5
≥550	18.1	18.1	18.1
Hospital – urban setting	90.3	90.7	90.0	0.0003
Teaching hospital	47.3	47.3	47.4	0.86

Note:

a All values are % unless otherwise specified.

Abbreviation: OIC, opioid-induced constipation.

Table 2 Unadjusted and adjusted hospital LOS and total cost in matched cohorta

	Unadjusted analyses			Adjusted analyses
	With OIC, mean (SD)	Without OIC, mean (SD)	p-value	With OIC, mean (95% CI)	Without OIC, mean (95% CI)	p-value
Index hospitalization LOS (days)	3.7 (2.5)	3.2 (1.8)	<0.0001	3.56 (3.54–3.57)	3.29 (3.27–3.30)	<0.0001
Total patient costs for index hospitalization	17,746 ($31,151)	$16,015 ($8,747)	0.008	$17,479 ($17,449–$17,510)	$16,265 ($16,237–$16,295)	<0.0001

Note:

a All costs shown are in US dollars.

Abbreviations: LOS, length of stay; OIC, opioid-induced constipation.

Table 3 Unadjusted and adjusted ICU admissions, mortality, 30-day readmissions, and 30-day ED visits in matched cohort

	Unadjusted analyses			Adjusted analyses
	With OIC (%)	Without OIC (%)	p-value	OR with OIC versus without OIC (95% CI)
ICU admissions during index	2.7	1.9	<0.0001	1.12 (1.01–1.24)
Death during index hospitalization	0.14	0.13	<0.0001	0.89 (0.59–1.35)
30-day readmissions	9.6	8.1	<0.0001	1.16 (1.11–1.22)
30-day ED visits	0.4	0.3	0.0001	1.38 (1.07–1.79)

Abbreviations: ED, emergency department; ICU, intensive care unit; OIC, opioid-induced constipation; OR, odds ratio.

Table S1 Patient and hospital characteristics for the overall cohort with and without OICa

	Overall cohort, N =788,448
	All	With OIC, n=40,891	Without OIC, n=747,557	p-value
Age, years, mean (SD)	66 (11)	68 (11)	66 (11)	<0.001
Sex, men	39.9	37.1	40.1	<0.001
Race
Caucasian	80.8	81.3	80.7	0.002
Black	8.0	8.0	8.0
Other	11.2	10.7	11.3
Payer
Medicare	55.5	63.6	55.0	<0.001
Medicaid	3.8	3.8	3.8
Managed care	29.3	22.6	29.6
Other	11.4	10.1	11.5
Admission source
Home	98.4	98.4	98.4	<0.001
Transferred from acute care facility	0.6	0.8	0.6
Transferred from skilled nursing facility	0.2	0.2	0.2
Other/unknown	0.8	0.6	0.8
Admission type
Elective	94.0	93.4	94.1	<0.001
Emergency	1.9	3.5	1.8
Trauma	0.0	0.1	0.0
Urgent	3.7	2.7	3.8
Other	0.3	0.3	0.3
Comorbidities during index encounter
Myocardial infarction	3.5	4.4	3.5	<0.001
Heart failure	2.6	4.1	2.5	<0.001
Peripheral vascular disease	2.2	3.0	2.1	<0.001
Cerebrovascular disease	0.7	1.1	0.7	<0.001
Dementia	0.1	0.1	0.1	<0.001
Chronic pulmonary disease	15.5	18.3	15.4	<0.001
Rheumatologic disease	4.3	4.9	4.2	<0.001
Peptic ulcer disease	0.5	0.8	0.5	<0.001
Mild liver disease	0.3	0.4	0.3	0.05
Moderate-to-severe liver disease	0.0	0.0	0.0	0.24
Diabetes	18.4	19.3	18.3	<0.001
Diabetes with chronic complications	1.4	2.1	1.4	<0.001
Hemiplegia or paraplegia	0.1	0.1	0.1	<0.001
Renal disease	5.3	8.3	5.1	<0.001
Any malignancy	1.0	1.4	1.0	<0.001
Metastatic solid tumor	0.1	0.3	0.1	<0.001
AIDS/HIV	0.1	0.1	0.1	0.37
Charlson Comorbidity Index, mean (SD)	0.7 (1.1)	0.9 (1.3)	0.7 (1.0)	<0.001
Chronic pain	4.4	7.1	4.2	<0.001
Hemodialysis	0.2	0.4	0.2	<0.001
Use of peripheral µ-opioid receptor antagonists	0.1	1.0	0.1	<0.001
Use of selected pro-motility drugs and stool softeners	86.1	88.5	85.9	<0.001
Total oral morphine equivalents (mg) for index hospitalization, mean (SD)	115.3 (186.7)	129.1 (236.8)	114.6 (183.6)	<0.001
Total days of opioid use, mean (SD)	3.1 (1.5)	3.5 (2.1)	3 (1.5)	<0.001
Hospital geographic divisions
New England	5.4	3.2	5.5
Middle Atlantic	10.4	14.7	10.1
East North Central	13.4	19.6	13.0
West North Central	6.4	8.9	6.3
South Atlantic	28.5	22.5	28.8	<0.001
East South Central	9.7	9.9	9.7
West South Central	8.4	7.6	8.5
Mountain	7.0	5.5	7.0
Pacific	10.9	8.1	11.1
Hospital bed capacity
<150	14.6	12.8	14.7
150–249	17.7	15.0	17.9
250–349	20.0	20.4	19.9	<0.001
350–449	16.7	15.6	16.7
450–549	13.3	18.2	13.0
≥550	17.8	18.1	17.8
Hospital – urban setting	89.1	90.7	89.0	<0.001
Teaching hospital	40.1	47.3	39.8	<0.001

Note:

a All values are % unless otherwise specified.

Abbreviation: OIC, opioid-induced constipation.