PAIN IN INFLAMMATORY BOWEL DISEASE (IBD): DOES OPIOID USE PREDICT WORSE HOSPITAL OUTCOMES?

Abstract

Abstract BACKGROUND Opioid use has been hypothesized to be a marker for increased severity of (IBD) for patients because those patients are more likely to require surgical intervention and have uncontrolled pain. Previous studies have not compared outcomes between patients with opioid use and dependence with IBD compared to patients with IBD not using opioids. Our study aims to investigate hospital mortality, hospital length of stay (LOS), and total charges between both patient groups. METHODS Data were extracted from the National Inpatient Sample (NIS) 2016-2019 Database. The NIS was searched for hospitalizations for adult patients with IBD, including ulcerative colitis (UC) and Crohn’s (CD), as a principal discharge diagnosis with opioid use and dependence as a secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. STATA software was used for analysis. RESULTS Among 1,165,075 patients who had IBD, 33,195 (2.8%) had concomitant opioid usage and dependence. The adjusted odds ratio (OR) for inpatient mortality (OR +2.8, p<0.018), LOS (+1.47 days, p<0.0001), and total hospital charges (+8,982, p<0.0001) for IBD and opioid use compared to those with only IBD were all statistically significant. Independent positive predictors of increased mortality were the following: fistula formation (OR 3.06), hematochezia (OR 2.85), electrolyte abnormalities (OR 1.48), bowel resection (OR 1.37), older age (OR 1.05) [p <0.0001 for all]. Interestingly, colonoscopy (OR 0.48, p<0.0001) and females (OR 0.79, p<0.0001) had less mortality. Independent positive predictors of increased LOS and total hospital charges were the following: fistula formation (+4.9 days, +$53,176 p<0.0001 for both), bowel obstruction (+1.2 days, +$9,228 p<0.0001 for both), hematochezia (+1.0, +14,977 days, p<0.0001 for both), electrolyte abnormalities (+2.0 days, +$16,793, p<0.0001, for both), colonoscopy (+1.9 days, +14,796, p<0.0001 for both), bowel resection (+4.5 days, +66,206, p<0.0001 for both). Total charges were also increased for Asian patients (+11,388, p<0.0001) and Hispanic patients (+10,177, p<0.0001). CONCLUSION Our study shows that there is significantly increased mortality, hospital LOS, and total charges for the subpopulation of IBD patients with opioid use and dependence. The presence of fistula formation, hematochezia, electrolyte abnormalities, older age, and prior bowel resection also portends higher mortality. Pain is a common complaint in patients with IBD and leads to increased morbidity. Our study is significant because it illustrates the importance of pain management in IBD and highlights the detrimental outcomes that come with opioid use and dependence. Further randomized trials would be helpful to study this patient population.