The Associations Between Opioid Use Disorder and Healthcare-Related Outcomes in Vaso-occlusive Crisis.
anemia
inpatients
opioid-related disorders
pain management
sickle cell disease
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
18 Mar 2024
18 Mar 2024
Historique:
received:
23
06
2023
accepted:
23
02
2024
medline:
19
3
2024
pubmed:
19
3
2024
entrez:
19
3
2024
Statut:
aheadofprint
Résumé
In patients who experience frequent vaso-occlusive crises (VOC), opioid dependence may be due to a need for pain control as opposed to addiction; the implications of opioid use disorder (OUD) in this population are unclear. To compare outcomes in hospitalizations for VOC in those with a history of OUD to those without a history of OUD. A retrospective assessment of hospitalizations for adults in the USA with a primary discharge diagnosis of VOC using the National Inpatient Sample database from 2016 to 2019. We also compared VOC hospitalizations to hospitalizations for all other reasons to assess differences in OUD-associated clinical factors. In total, 273,460 hospitalizations for VOC; 23,120 (8.5%) of these hospital stays involved a secondary diagnosis of OUD. Primary outcomes were length of hospital stay and cost. Mortality was a secondary outcome. Hospital length of stay was increased (mean 6.2 vs 4.9 days) in patients with OUD (adjusted rate ratio = 1.24, 95% CI 1.20-1.29, p < 0.001). Mean cost was also higher in those with OUD ($9076) than those without OUD ($8020, p < 0.001). Mortality was decreased in VOC hospitalizations in those with OUD, but the difference was not statistically significant (adjusted OR = 0.64, 95% CI 0.028-1.48, p = 0.30). OUD is associated with increased length of stay and costs in patients with VOC. While there are many possible explanations, providers should consider undertreatment of pain due to addiction concerns as a potential factor; individualized pain plans to mitigate this challenge could be explored.
Sections du résumé
BACKGROUND
BACKGROUND
In patients who experience frequent vaso-occlusive crises (VOC), opioid dependence may be due to a need for pain control as opposed to addiction; the implications of opioid use disorder (OUD) in this population are unclear.
OBJECTIVE
OBJECTIVE
To compare outcomes in hospitalizations for VOC in those with a history of OUD to those without a history of OUD.
DESIGN
METHODS
A retrospective assessment of hospitalizations for adults in the USA with a primary discharge diagnosis of VOC using the National Inpatient Sample database from 2016 to 2019. We also compared VOC hospitalizations to hospitalizations for all other reasons to assess differences in OUD-associated clinical factors.
PARTICIPANTS
METHODS
In total, 273,460 hospitalizations for VOC; 23,120 (8.5%) of these hospital stays involved a secondary diagnosis of OUD.
MAIN MEASURES
METHODS
Primary outcomes were length of hospital stay and cost. Mortality was a secondary outcome.
KEY RESULTS
RESULTS
Hospital length of stay was increased (mean 6.2 vs 4.9 days) in patients with OUD (adjusted rate ratio = 1.24, 95% CI 1.20-1.29, p < 0.001). Mean cost was also higher in those with OUD ($9076) than those without OUD ($8020, p < 0.001). Mortality was decreased in VOC hospitalizations in those with OUD, but the difference was not statistically significant (adjusted OR = 0.64, 95% CI 0.028-1.48, p = 0.30).
CONCLUSIONS
CONCLUSIONS
OUD is associated with increased length of stay and costs in patients with VOC. While there are many possible explanations, providers should consider undertreatment of pain due to addiction concerns as a potential factor; individualized pain plans to mitigate this challenge could be explored.
Identifiants
pubmed: 38499723
doi: 10.1007/s11606-024-08717-7
pii: 10.1007/s11606-024-08717-7
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.
Références
Kang HA, Barner JC, Richards KM, Bhor M, Paulose J, Kutlar A. Association Between Vaso-Occlusive Crises and Opioid Prescriptions Among Patients with Sickle Cell Disease: A Retrospective Claims-Based Study. J Health Econ Outcomes Res. 2020;7(1):94-101.
pubmed: 32685602
pmcid: 9981196
Ballas SK. Opioids and Sickle Cell Disease: From Opium to the Opioid Epidemic. J Clin Med. 2021;10(3).
pubmed: 33498726
pmcid: 7865837
doi: 10.3390/jcm10030438
Yawn BP, Buchanan GR, Afenyi-Annan AN, et al. Management of sickle cell disease: summary of the 2014 evidence-based report by expert panel members. JAMA. 2014;312(10):1033-48.
pubmed: 25203083
doi: 10.1001/jama.2014.10517
Carroll CP. Opioid treatment for acute and chronic pain in patients with sickle cell disease. Neurosci Lett. 2020;714:134534.
pubmed: 31593753
doi: 10.1016/j.neulet.2019.134534
Carroll CP, Lanzkron S, Haywood C, Jr., et al. Chronic Opioid Therapy and Central Sensitization in Sickle Cell Disease. Am J Prev Med. 2016;51(1 Suppl 1):S69-77.
pubmed: 27320469
pmcid: 5379857
doi: 10.1016/j.amepre.2016.02.012
Telfer P, Bahal N, Lo A, Challands J. Management of the acute painful crisis in sickle cell disease- a re-evaluation of the use of opioids in adult patients. Br J Haematol. 2014;166(2):157-64.
pubmed: 24750050
doi: 10.1111/bjh.12879
Field JJ. Five lessons learned about long-term pain management in adults with sickle cell disease. Hematology Am Soc Hematol Educ Program. 2017;2017(1):406-11.
doi: 10.1182/asheducation-2017.1.406
Cooper TE, Hambleton IR, Ballas SK, Johnston BA, Wiffen PJ. Pharmacological interventions for painful sickle cell vaso-occlusive crises in adults. Cochrane Database Syst Rev. 2019;2019(11).
pubmed: 31742673
pmcid: 6863096
Brandow AM, Carroll CP, Creary S, et al. American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv. 2020;4(12):2656-701.
pubmed: 32559294
pmcid: 7322963
doi: 10.1182/bloodadvances.2020001851
Ruta NS, Ballas SK. The Opioid Drug Epidemic and Sickle Cell Disease: Guilt by Association. Pain Med. 2016;17(10):1793-8.
pubmed: 27152018
doi: 10.1093/pm/pnw074
Shapiro BS, Benjamin LJ, Payne R, Heidrich G. Sickle cell-related pain: perceptions of medical practitioners. J Pain Symptom Manage. 1997;14(3):168-74.
pubmed: 9291703
doi: 10.1016/S0885-3924(97)00019-5
Sagi V, Mittal A, Tran H, Gupta K. Pain in sickle cell disease: current and potential translational therapies. Transl Res. 2021;234:141-58.
pubmed: 33711512
pmcid: 8217144
doi: 10.1016/j.trsl.2021.03.007
Linton EA, Goodin DA, Hankins JS, et al. A Survey-Based Needs Assessment of Barriers to Optimal Sickle Cell Disease Care in the Emergency Department. Ann Emerg Med. 2020;76(3S):S64-S72.
pubmed: 32928465
pmcid: 7511000
doi: 10.1016/j.annemergmed.2020.08.013
Centers for Disease Control and Prevention. (2023, July 6). Data & statistics on Sickle Cell Disease. https://www.cdc.gov/ncbddd/sicklecell/data.html . Accessed 6/30/2023.
Meghani SH, Byun E, Gallagher RM. Time to take stock: a meta-analysis and systematic review of analgesic treatment disparities for pain in the United States. Pain Med. 2012;13(2):150-74.
pubmed: 22239747
doi: 10.1111/j.1526-4637.2011.01310.x
Adams G, Salomons TV. Attending work with chronic pain is associated with higher levels of psychosocial stress. Can J Pain. 2021;5(1):107-16.
pubmed: 34189394
pmcid: 8210861
doi: 10.1080/24740527.2021.1889925
Brown SE, Weisberg DF, Balf-Soran G, Sledge WH. Sickle cell disease patients with and without extremely high hospital use: pain, opioids, and coping. J Pain Symptom Manage. 2015;49(3):539-47.
pubmed: 25057985
doi: 10.1016/j.jpainsymman.2014.06.007
Kavanagh PL, Fasipe TA, Wun T. Sickle Cell Disease: A Review. JAMA. 2022;328(1):57-68.
pubmed: 35788790
doi: 10.1001/jama.2022.10233
Salsitz EA. Chronic Pain, Chronic Opioid Addiction: a Complex Nexus. J Med Toxicol. 2016;12(1):54-7.
pubmed: 26602212
doi: 10.1007/s13181-015-0521-9
Feliu MH, Wellington C, Crawford RD, et al. Opioid management and dependency among adult patients with sickle cell disease. Hemoglobin. 2011;35(5-6):485-94.
pubmed: 21910605
doi: 10.3109/03630269.2011.610914
Smith WR, McClish DK, Roberts JD, et al. Prescription Opioid Misuse Index in sickle cell patients: A brief questionnaire to assess at-risk for opioid abuse. J Opioid Manag. 2019;15(4):323-31.
pubmed: 31637684
doi: 10.5055//jom.2019.0517
Bolshakova M, Bluthenthal R, Sussman S. Opioid use and misuse: health impact, prevalence, correlates and interventions. Psychol Health. 2019;34(9):1105-39.
pubmed: 31177850
pmcid: 7456364
doi: 10.1080/08870446.2019.1622013
Ballas SK, Kanter J, Agodoa I, et al. Opioid utilization patterns in United States individuals with sickle cell disease. Am J Hematol. 2018;93(10):E345-E7.
pubmed: 30051929
doi: 10.1002/ajh.25233
Elander J, Lusher J, Bevan D, Telfer P. Pain management and symptoms of substance dependence among patients with sickle cell disease. Soc Sci Med. 2003;57(9):1683-96.
pubmed: 12948577
doi: 10.1016/S0277-9536(02)00553-1
Russo K, Chhunchha P. Patient-Controlled Analgesia vs Intravenous Push Hydromorphone for Pain Management of Vaso-Occlusive Crisis Associated With Sickle Cell Disease. J Pain Palliat Care Pharmacother. 2023;37(2):116-22.
pubmed: 36701332
doi: 10.1080/15360288.2023.2167035
Katsivalis KV, Kosacz J, Austin Szwak J. Opioid Use in Vaso-Occlusive Crisis During Intravenous Opioid Drug Shortage. Hosp Pharm. 2022;57(6):721-6.
pubmed: 36340631
pmcid: 9631012
doi: 10.1177/00185787221095894
Summers S, Grau L, Massel D, Rosas S, Ong A, Hernandez VH. Opioid Use Disorders Are Associated With Perioperative Morbidity and Mortality in the Hip Fracture Population. J Orthop Trauma. 2018;32(5):238-44.
pubmed: 29356800
doi: 10.1097/BOT.0000000000001118
Gharbin J, Winful A, Hassan MA, et al. Differences in the Clinical Outcome of Ischemic and Nonischemic Cardiomyopathy in Heart Failure With Concomitant Opioid Use Disorder. Curr Probl Cardiol. 2023;48(5):101609.
pubmed: 36690309
doi: 10.1016/j.cpcardiol.2023.101609
Shaikh AS, Al Mouslmani MY, Raza Shah A, et al. Preexisting opioid use disorder is associated with poor outcomes in hospitalized acute pancreatitis patients. Eur J Gastroenterol Hepatol. 2021;33(11):1348-53.
pubmed: 34402465
doi: 10.1097/MEG.0000000000002265
Wilson JD, Lanzkron S, Pecker LH, Bediako SM, Han D, Beach MC. Psychosocial and Clinical Risk Factors Associated with Substance Use in Observational Cohort of Patients with Sickle Cell Disease. Subst Use Misuse. 2020;55(13):2205-12.
pubmed: 32762425
pmcid: 8208322
doi: 10.1080/10826084.2020.1797807
Webster LR. Risk Factors for Opioid-Use Disorder and Overdose. Anesth Analg. 2017;125(5):1741-8.
pubmed: 29049118
doi: 10.1213/ANE.0000000000002496
Song Y, Tang R, Roses RE, et al. Opioid Use Disorder is Associated With Complications and Increased Length of Stay After Major Abdominal Surgery. Ann Surg. 2021;274(6):992-1000.
pubmed: 31800489
doi: 10.1097/SLA.0000000000003697
Medicaid Outcomes Distributed Research N, Donohue JM, Jarlenski MP, et al. Use of Medications for Treatment of Opioid Use Disorder Among US Medicaid Enrollees in 11 States, 2014-2018. JAMA. 2021;326(2):154-64.
doi: 10.1001/jama.2021.7374
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-9.
pubmed: 1607900
doi: 10.1016/0895-4356(92)90133-8
Gutacker N, Bloor K, Cookson R. Comparing the performance of the Charlson/Deyo and Elixhauser comorbidity measures across five European countries and three conditions. Eur J Public Health. 2015;25 Suppl 1:15-20.
pubmed: 25690125
doi: 10.1093/eurpub/cku221
McCavit TL, Lin H, Zhang S, Ahn C, Quinn CT, Flores G. Hospital volume, hospital teaching status, patient socioeconomic status, and outcomes in patients hospitalized with sickle cell disease. Am J Hematol. 2011;86(4):377-80.
pubmed: 21442644
pmcid: 4250088
doi: 10.1002/ajh.21977
Pokhrel A, Olayemi A, Ogbonda S, Nair K, Wang JC. Racial and ethnic differences in sickle cell disease within the United States: From demographics to outcomes. Eur J Haematol. 2023;110(5):554-63.
pubmed: 36710488
doi: 10.1111/ejh.13936
Kumar V, Chaudhary N, Achebe MM. Epidemiology and Predictors of all-cause 30-Day readmission in patients with sickle cell crisis. Sci Rep. 2020;10(1):2082.
pubmed: 32034210
pmcid: 7005718
doi: 10.1038/s41598-020-58934-3
Ballas SK. Opioids are not a major cause of death of patients with sickle cell disease. Ann Hematol. 2021;100(5):1133-8.
pubmed: 33758998
doi: 10.1007/s00277-021-04502-2
Lee SW, Shen J, Kim SJ, et al. US Trends of Opioid-use Disorders and Associated Factors Among Hospitalized Patients With Spinal Conditions and Treatment From 2005 to 2014. Spine (Phila Pa 1976). 2020;45(2):124-33.
pubmed: 31851144
doi: 10.1097/BRS.0000000000003183
Osborne JC, Osakwe Z, Odlum M. Opioid Use in Adults With Sickle Cell Disease Hospitalized During Vaso-Occlusive Crisis: A Systematic Review. J Hematol. 2021;10(2):46-52.
pubmed: 34007365
pmcid: 8110229
doi: 10.14740/jh828
Burstein DS, Svigos F, Patel A, et al. A Scoping Review on the Concept of Physician Caring. J Gen Intern Med. 2022;37(12):3134-46.
pubmed: 35391622
pmcid: 8989128
doi: 10.1007/s11606-021-07382-4
Lanzkron S, Carroll CP, Haywood C, Jr. The burden of emergency department use for sickle-cell disease: an analysis of the national emergency department sample database. Am J Hematol. 2010;85(10):797-9.
pubmed: 20730795
pmcid: 3431910
doi: 10.1002/ajh.21807
The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020;14(2S Suppl 1):1–91.
Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022;71(3):1-95.
pubmed: 36327391
pmcid: 9639433
doi: 10.15585/mmwr.rr7103a1
Mager A, Pelot K, Koch K, et al. Opioid management strategy decreases admissions in high-utilizing adults with sickle cell disease. J Opioid Manag. 2017;13(3):143-56.
pubmed: 28829516
doi: 10.5055/jom.2017.0382
Della-Moretta S, Delatore L, Purcell M, et al. The Effect of Use of Individualized Pain Plans in Sickle Cell Patients Presenting to the Emergency Department. Ann Emerg Med. 2020;76(3S):S21-S7.
pubmed: 32928458
doi: 10.1016/j.annemergmed.2020.08.008
Pecker LH, Darbari DS. Psychosocial and affective comorbidities in sickle cell disease. Neurosci Lett. 2019;705:1-6.
pubmed: 30965108
doi: 10.1016/j.neulet.2019.04.011
Welch-Coltrane JL, Wachnik AA, Adams MCB, et al. Implementation of Individualized Pain Care Plans Decreases Length of Stay and Hospital Admission Rates for High Utilizing Adults with Sickle Cell Disease. Pain Med. 2021;22(8):1743-52.
pubmed: 33690845
pmcid: 8346918
doi: 10.1093/pm/pnab092