Patterns of Inpatient Opioid Use and Related Adverse Events Among Patients With Cirrhosis: A Propensity-Matched Analysis.

Jessica B Rubin,Andrew Auerbach,Amy M Shui,Samuel F Hohmann,Jennifer C Lai

doi:10.1002/hep4.1694

Jessica B Rubin, Andrew Auerbach + Show 3 more

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https://doi.org/10.1002/hep4.1694

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Abstract

Pain is common among patients with cirrhosis, yet managing pain in this population is challenging. Opioid analgesics are thought to be particularly high risk in patients with cirrhosis, and their use has been discouraged. We sought to understand patterns of opioid use among inpatients with cirrhosis and the risks of serious opioid‐related adverse events in this population. We used the Vizient Clinical Database/Resource Manager, which includes clinical and billing data from hospitalizations at more than 500 academic medical centers. We identified all nonsurgical patients with cirrhosis hospitalized in 2017‐2018 as well as a propensity score‐matched cohort of patients without cirrhosis. Inpatient prescription records defined patterns of inpatient opioid use. Conditional logistic regression compared rates of use and serious opioid‐related adverse events between patients with and without cirrhosis. Of 116,146 nonsurgical inpatients with cirrhosis, 62% received at least one dose of opioids and 34% had regular inpatient opioid use (more than half of hospital days), rates that were significantly higher than in patients without cirrhosis (adjusted odds ratio [AOR] for any use, 1.17; 95% confidence interval [CI], 1.13‐1.21; P < 0.001; AOR for regular use, 1.07; 95% CI, 1.02‐1.11; P = 0.002). Compared with patients without cirrhosis, patients with cirrhosis more often received tramadol (P < 0.001) and less commonly received opioid/acetaminophen combinations (P < 0.001). Rates of serious opioid‐related adverse events were similar in patients with and without cirrhosis (1.6% vs. 1.9%; AOR, 0.96; P = 0.63). Conclusion: Over half of patients with cirrhosis have pain managed with opioids during hospitalization. Patterns of opioid use differ in patients with cirrhosis compared with patients without cirrhosis, although rates of serious adverse events are similar. Future studies should further explore the safety and efficacy of opioids in patients with cirrhosis, with the goal of improving pain management and quality of life in this population.

Highlights

Title Patterns of Inpatient Opioid Use and Related Adverse Events Among Patients With Cirrhosis: A Propensity-Matched Analysis
In an effort to understand whether patients were likely to receive opioids because of chronic or outpatient use, we identified the proportion of patients with one of four ICD-1 0-C M diagnosis codes for chronic pain that have been validated in the literature.[20]. We identified patients with one of 143 opioid-related ICD-1 0-C M diagnosis codes either for opioid abuse or opioid poisoning, as defined by the Agency for Healthcare Research and Quality (AHRQ).[21]
Among patients with regular inpatient opioid use, rates of serious opioid-related adverse events were low and patients with cirrhosis appeared to have similar rates of these adverse events compared with patients without cirrhosis, with slightly lower risk of adverse events in those with decompensated disease

Summary

Introduction

Title Patterns of Inpatient Opioid Use and Related Adverse Events Among Patients With Cirrhosis: A Propensity-Matched Analysis. Patterns of Inpatient Opioid Use and Related Adverse Events Among Patients With Cirrhosis: A Propensity-Matched Analysis. We sought to understand patterns of opioid use among inpatients with cirrhosis and the risks of serious opioid-related adverse events in this population. Conditional logistic regression compared rates of use and serious opioid-related adverse events between patients with and without cirrhosis. Rates of serious opioid-related adverse events were similar in patients with and without cirrhosis (1.6% vs 1.9%; AOR, 0.96; P = 0.63). Patterns of opioid use differ in patients with cirrhosis compared with patients without cirrhosis, rates of serious adverse events are similar. Future studies should further explore the safety and efficacy of opioids in patients with cirrhosis, with the goal of improving pain management and quality of life in this population.

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