90 Factors Associated With Increased Opioid Use in a Retrospective Cohort of 14,140 Acute Pancreatitis Patients

Abstract

INTRODUCTION: Pain management is a critical component of treating acute pancreatitis (AP). No guidelines exist on optimal pain management strategies. Opioids have become a mainstay in the treatment of pain in AP, but there are uncertainties regarding their effectiveness and concerns about their safety. The risk of subsequent opioid dependence (OD) after developing AP has not been well-studied. Our aim is to 1) Investigate the risk of developing OD after having AP, and 2) Evaluate whether patient factors such as age, gender, race, and insurance status affect the risk of developing OD after AP. METHODS: We performed a retrospective analysis in the IBM Explorys database (1999–2019), a pooled, de-identified clinical database of over 63 million unique patients across the United States. At the time of analysis there were 63,566,840 patients. Patient populations were identified using SNOMED and ICD codes. Odds ratios were calculated to determine the relationship between AP and OD for the population subgroups outlined above. RESULTS: 316,450 patients had AP from 1999–2019. 14,140 of these patients also were OD. The odds of being OD after AP was 11.06 (95% CI 10.87, 11.25). Patients under the age of 65 years had the highest risk of developing OD. Patients with Medicaid had the highest risk of any type of medical insurance. Females were more likely to develop OD than males. Caucasian and African American patients had a similar risk of becoming OD. Asian patients were least likely to develop OD. Full results are listed in Table 1. Corresponding Forrest plots of this data are illustrated in Figure 1. CONCLUSION: Our results are consistent with what has been observed previously, as an evaluation of opioid use among inpatients with AP also found a significant variation in opioid use among hospitalized patients. High doses of opioids have been shown to result in longer hospitalizations and more adverse outcomes. Prospective trials and systematic reviews have not found that any particular analgesic is superior for pain control in AP patients. There is currently a lack of clinical guidance on the utility and efficacy of using opioids in managing pain from AP. We hope that our results can inform clinicians of different patient factors that may increase the risk of OD after having AP. Future use of drug monitoring systems and electronic health record utilization may help further analyze factors associated with persistent opioid use.