The Impact Of Hospital Nursing Resources On Postsurgical Outcomes For Patients With Opioid Use Disorder

Rachel Elizabeth French, University of Pennsylvania

Abstract

Opioid use disorder (OUD) is common, with the rate of opioid-related hospitalizations doubling from 2006 to 2016. Surgical patients with OUD are at significantly higher risk of prolonged length of stay, in-hospital mortality, and readmission. Postoperative care for patients with OUD is particularly challenging for nurses whose responsibilities include pain and withdrawal management, care team coordination, patient assessment, and patient teaching. A large body of evidence suggests better outcomes for surgical patients when they are cared for in hospitals with strong nursing resources. This study sought to determine whether variations in nursing resources (i.e., education, staffing, and work environment) were associated with postsurgical outcomes (i.e., length of stay, in-hospital 30-day mortality, and 7, 30, 60, and 90-day readmission) for patients with and without OUD (Aim 1). This cross-sectional analysis leveraged 2015-2016 data of nurse survey responses, patient discharge abstracts, and hospital characteristics. The final sample included 919,601 patients across 448 hospitals in California, Florida, New Jersey, and Pennsylvania. Logistic and zero truncated negative binomial regression models were used to estimate the relationships between nursing resources and surgical patient outcomes. After adjustments, we found that each 10% increase in the proportion of bachelors-educated nurses was associated with lower odds of readmission at 7 (OR 0.95, p-value = 0.001), 30 OR 0.95, p-value <0.001), 60 (OR 0.95, p-value <0.001), and 90 (OR 0.95, p-value <0.001) days for all surgical patients, and that this effect was even stronger for surgical patients with OUD (i.e., 15% lower odds for 7-day readmission; 16% for 30-day readmission; 14% for 60-day readmission; and 14% for 90-day readmission). In adjusted models, we also found that each additional patient-per-nurse was associated with higher odds of readmission for surgical patients with OUD (i.e., 13% higher odds for 7-day readmission and 10% for 30-day readmission). A substantial proportion of surgical patients with OUD are readmitted, and the odds of readmission are lessened when these patients are cared for in hospitals with better nurse education and staffing. Findings from this study can inform organizational strategies to reduce readmissions following needed surgical care for people already suffering from OUD.