Correspondence  |   January 2019
Association and Effect of Opioid Abuse—Related Readmission
Author Notes
  • UTHealth McGovern Medical School, Houston, Texas. evan.g.pivalizza@uth.tmc.edu
  • (Accepted for publication October 2, 2018.)
    (Accepted for publication October 2, 2018.)×
Article Information
Correspondence
Correspondence   |   January 2019
Association and Effect of Opioid Abuse—Related Readmission
Anesthesiology 1 2019, Vol.130, 174. doi:10.1097/ALN.0000000000002497
Anesthesiology 1 2019, Vol.130, 174. doi:10.1097/ALN.0000000000002497
Although the medical community is appropriately alarmed and galvanized to action by the current opioid epidemic in our nation, associations can be easily ascribed and portrayed as scientific certainty. In a recent large database study, Gupta et al. posited in their title that “Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures.”1  This title, however, is at odds with more cautiously crafted “association” statements in the abstract conclusion, discussion, and concluding paragraph, which more appropriately describe the retrospective findings.
I applaud the authors for the sheer magnitude of the study and the data describing the presumed inherent risk for this patient cohort. “Adjusted analysis” cannot obfuscate, however, the message apparent from a careful reading of the presented data. I defer to the statistical expertise and skill of the authors, but the presented medical conditions and risks of the opioid abuse/dependence group are significantly different (in exponentially large effect) in 29 of the 32 presented comorbidities spanning every clinically relevant major organ system (table 2). It is not surprising that the odds ratio of the multivariate model (table 4) has several positive predictors of readmission of greater or equal magnitude than opioid abuse/dependence (odds ratio, 1.26), including the following: