Incidence, risk factors, and outcomes of opioid overdose after major gastrointestinal surgery.

BACKGROUND Perioperative opioid overdose (OD) is a rare but serious complication. However, data on OD risk factors and outcomes after gastrointestinal (GI) surgery remain limited. This study aimed to define the risk factors and outcomes of opioid OD after major GI surgery.

METHODS Data on opioid OD were extracted from the National Inpatient Sample (2016-2019), which included adults who underwent major GI surgery. Patients were categorized into opioid OD and non-OD cohorts; outcomes included in-hospital complications, mortality, length of stay (LOS), and hospitalization costs. Multivariate regression analyses were performed to estimate the association between opioid OD and outcomes.

RESULTS Among 1,562,770 patients in the weighted population, 1434 (0.1%) experienced perioperative opioid OD. Compared with patients without OD, those with opioid OD were predominantly female (807,450 [51.7%] vs 940 [65.5%], respectively; P<.001) and more likely to have Medicaid insurance (152,555 [9.8%] vs 230 [16.0%], respectively; P<.001). The incidence of opioid OD declined from 0.12% in 2016 to 0.07% in 2019. On adjusted analyses, compared with colectomy, esophagectomy (adjusted odds ratio [AOR], 3.78 [95% CI, 2.01-7.11]), hepatectomy (AOR, 2.08 [95% CI, 1.13-3.83]), and pancreatectomy (AOR, 1.90 [95% CI, 1.10-3.26]) were associated with higher odds of OD, emergency admissions (AOR, 1.99 [95% CI, 1.49-2.67]), and drug abuse disorder (AOR, 4.51 [95% CI, 3.11-6.55]). Opioid OD was associated with higher odds of renal complications (AOR, 2.77 [95% CI, 2.07-3.72]), longer LOS (+2.97 days [95% CI, +1.67 to +4.28]), and increased costs (+$14,320 [95% CI, +$9110 to +$19,520]).

CONCLUSION Opioid OD was associated with substantial morbidity, prolonged hospitalization, and increased costs. Temporal decline with persistent risk among vulnerable individuals highlights the need for systematic perioperative substance screening and structured stewardship programs in major GI surgery care.