Abstract P393: Risk Factors for Opioid Use in Patients With Intracerebral Hemorrhage

Abstract

Background: Opioids are often used as analgesics in patients with subarachnoid hemorrhage, but their use in the setting of intracerebral hemorrhage (ICH) is not well described. We aimed to determine risk factors for opioid use in both the acute and post-discharge settings in patients with ICH. Methods: We analyzed data from a single-center cohort of consecutive ICH patients admitted over two years. Demographics and ICH-related characteristics were prospectively collected as part of an institutional ICH registry, while pre-morbid, in-hospital, and post-discharge medications were retrospectively abstracted from medication administration records and physician documentation. After excluding patients who received end-of-life care, we used multivariable regression models adjusted for pre-morbid opioid use to determine demographic and ICH-related risk factors for in-hospital and post-discharge opioid use. Results: Of 468 patients in our cohort, 15% (n=70) had pre-morbid opioid use, 53% (n=248) had in-hospital opioid use, and 12% (n=53) of survivors had opioids prescribed at discharge. The most commonly used in-hospital opioids were fentanyl (38% of patients), oxycodone (30%), morphine (26%), and hydromorphone (7%). Patients who received in-hospital opioids were significantly younger (mean 62.7 vs. 74.0 years, p<0.001) and had larger ICH volumes (mean 18.7 vs. 8.1 cc, p<0.001), with additional risk factors including infratentorial location (OR 4.0, 95% CI 2.0-8.0), presence of intraventricular hemorrhage (OR 4.3, 95% CI 2.5-7.5), and vascular, neoplastic, or other secondary ICH etiologies (OR 2.6, 95% CI 1.4-4.7) in multivariable models. However, only secondary ICH etiologies (OR 4.1, 95% CI 1.8-9.1) remained significant risk factors for opioid prescriptions at discharge in ICH survivors. Conclusion: Inpatient opioid use in ICH patients is common, with risk factors that may be mechanistically connected to headache pathophysiology. However, the lower frequency of post-discharge opioid prescriptions may be reassuring given the prevalence of opioid dependence nationwide.