Cardiac Surgery in Patients With Opioid Use Disorder: An Analysis of 1.7 Million Surgeries

Ann Thorac Surg. 2020 Apr;109(4):1194-1201. doi: 10.1016/j.athoracsur.2019.07.041. Epub 2019 Aug 31.


Background: Adverse repercussions associated with the current opioid epidemic have been documented in many surgical specialties. This study evaluated the impact of opioid use disorder (OUD) on in-hospital cardiac surgery outcomes by using a large national database.

Methods: Using the National Inpatient Sample, this study isolated patients undergoing coronary artery bypass grafting, valve repair, or valve replacement from 2009 to 2014. Patients were stratified by OUD status. Multivariable analysis was performed to evaluate the association between opioid use and postoperative outcomes. Patients were further stratified by surgery type.

Results: Overall, 1,743,161 patients underwent cardiac surgery, and 6960 patients had OUD (0.4%). Mean age was 47.2 and 65.8 years among those with and without OUD, respectively. Although in-hospital mortality did not differ among these groups, patients with OUD had a significantly higher incidence of stroke (8.3% vs 2.8%) and acute kidney injury (21.4% vs 16.2%), longer hospital stays (18 days vs 10 days), and higher hospitalization costs ($81,238 vs $58,654; all P < .01). However, after adjusting for patient and hospital-level factors, OUD was associated only with a longer hospital length of stay (2.2 days; 95% confidence interval, 1.19 to 3.20) compared with non-opioid users.

Conclusions: OUD among cardiac surgery patients is associated with prolonged hospitalization and increased risk of postoperative morbidity, mainly driven by the patient's preoperative risk factors. Strategies to minimize these risk factors at the prehospitalization level is warranted to curb the opioid epidemic and improve overall outcomes in this vulnerable population.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Analgesics, Opioid / adverse effects*
  • Cardiac Surgical Procedures / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Heart Diseases / complications
  • Heart Diseases / surgery*
  • Hospital Mortality / trends
  • Humans
  • Male
  • Middle Aged
  • Morbidity / trends
  • Opioid-Related Disorders / complications*
  • Opioid-Related Disorders / epidemiology
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Survival Rate / trends
  • Time Factors
  • United States / epidemiology


  • Analgesics, Opioid