Abstract
ObjectiveSeveral studies show that chronic opioid dependence leads to higher in-hospital mortality, increased risk of hospital readmissions, and worse outcomes in trauma cases. However, the association of outpatient prescription opioid use on morbidity and mortality has not been adequately evaluated in a critical care setting. The purpose of this study was to determine if there is an association between chronic opioid use and mortality after an ICU admission.DesignA single-center, longitudinal retrospective cohort study of all Intensive Care Unit (ICU) patients admitted to a tertiary-care academic medical center from 2001 to 2012 using the MIMIC-III database.SettingMedical Information Mart for Intensive Care III database based in the United States.PatientsAdult patients 18 years and older were included. Exclusion criteria comprised of patients who expired during their hospital stay or presented with overdose; patients with cancer, anoxic brain injury, non-prescription opioid use; or if an accurate medication reconciliation was unable to be obtained. Patients prescribed chronic opioids were compared with those who had not been prescribed opioids in the outpatient setting.InterventionsNone.Measurements and main resultsThe final sample included a total of 22,385 patients, with 2,621 (11.7%) in the opioid group and 19,764 (88.3%) in the control group. After proceeding with bivariate analyses, statistically significant and clinically relevant differences were identified between opioid and non-opioid users in sex, length of hospital stay, and comorbidities. Opioid use was associated with increased mortality in both the 30-day and 1-year windows with a respective odds ratios of 1.81 (95% CI, 1.63–2.01; p<0.001) and 1.88 (95% CI, 1.77–1.99; p<0.001), respectively.ConclusionsChronic opioid usage was associated with increased hospital length of stay and increased mortality at both 30 days and 1 year after ICU admission. Knowledge of this will help providers make better choices in patient care and have a more informed risk-benefits discussion when prescribing opioids for chronic usage.
Highlights
Opioid dependence is a significant contributor to the global burden of disease [1]
Chronic opioid usage was associated with increased hospital length of stay and increased mortality at both 30 days and 1 year after Intensive Care Unit (ICU) admission
Studies show that chronic opioid dependence leads to higher in-hospital mortality, increased risk of hospital readmissions, and worse outcomes in trauma cases [8,9,10]
Summary
Opioid dependence is a significant contributor to the global burden of disease [1]. The opioid crisis in the US has been apparent and a target of many interventions. Studies show that chronic opioid dependence leads to higher in-hospital mortality, increased risk of hospital readmissions, and worse outcomes in trauma cases [8,9,10]. The purpose of this study was to determine whether a statistically significant association exists between chronic opioid use and mortality after an ICU stay. We explore the association of illness severity on admission, change in illness severity after admission, comorbidities and demographics on this outcome To do this we developed three models for each of the outcomes: length of hospital stay, 30-day mortality and 1-year mortality. Knowledge of this will help providers make better choices in patient care and have a more informed risk-benefits discussion when prescribing opioids for chronic usage
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
