BACKGROUND: Recent studies in the outpatient setting have demonstrated high rates of opioid prescribing and overdose-related deaths. Prescribing practices in hospitalized patients are unexamined. OBJECTIVE: To investigate patterns and predictors of opioid utilization in nonsurgical admissions to US hospitals, variation in use, and the association between hospital-level use and rates of severe opioid-related adverse events. DESIGN, SETTING, AND PATIENTS: Adult nonsurgical admissions to 286 US hospitals. MEASUREMENTS: Opioid exposure and severe opioid-related adverse events during hospitalization, defined using hospital charges and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. RESULTS: Of 1.14 million admissions, opioids were used in 51%. The mean ± standard deviation daily dose received in oral morphine equivalents was 68 ± 185 mg; 23% of exposed received a total daily dose of ≥100 mg oral morphine equivalents. Opioid-prescribing rates ranged from 5% in the lowest-prescribing hospital to 72% in the highest-prescribing hospital (mean, 51% ± 10%). After adjusting for patient characteristics, the adjusted opioid-prescribing rates ranged from 33% to 64% (mean, 50% ± standard deviation 4%). Among exposed, 0.60% experienced severe opioid-related adverse events. Hospitals with higher opioid-prescribing rates had higher adjusted relative risk of a severe opioid-related adverse event per patient exposed (relative risk: 1.23 [1.14-1.33] for highest-prescribing compared with lowest-prescribing quartile). CONCLUSIONS: The majority of hospitalized nonsurgical patients were exposed to opioids, often at high doses. Hospitals that used opioids most frequently had increased adjusted risk of a severe opioid-related adverse event per patient exposed. Interventions to standardize and enhance the safety of opioid prescribing in hospitalized patients should be investigated.
BACKGROUND: Recent studies in the outpatient setting have demonstrated high rates of opioid prescribing and overdose-related deaths. Prescribing practices in hospitalized patients are unexamined. OBJECTIVE: To investigate patterns and predictors of opioid utilization in nonsurgical admissions to US hospitals, variation in use, and the association between hospital-level use and rates of severe opioid-related adverse events. DESIGN, SETTING, AND PATIENTS: Adult nonsurgical admissions to 286 US hospitals. MEASUREMENTS: Opioid exposure and severe opioid-related adverse events during hospitalization, defined using hospital charges and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. RESULTS: Of 1.14 million admissions, opioids were used in 51%. The mean ± standard deviation daily dose received in oral morphine equivalents was 68 ± 185 mg; 23% of exposed received a total daily dose of ≥100 mg oral morphine equivalents. Opioid-prescribing rates ranged from 5% in the lowest-prescribing hospital to 72% in the highest-prescribing hospital (mean, 51% ± 10%). After adjusting for patient characteristics, the adjusted opioid-prescribing rates ranged from 33% to 64% (mean, 50% ± standard deviation 4%). Among exposed, 0.60% experienced severe opioid-related adverse events. Hospitals with higher opioid-prescribing rates had higher adjusted relative risk of a severe opioid-related adverse event per patient exposed (relative risk: 1.23 [1.14-1.33] for highest-prescribing compared with lowest-prescribing quartile). CONCLUSIONS: The majority of hospitalized nonsurgical patients were exposed to opioids, often at high doses. Hospitals that used opioids most frequently had increased adjusted risk of a severe opioid-related adverse event per patient exposed. Interventions to standardize and enhance the safety of opioid prescribing in hospitalized patients should be investigated.
Authors: G T O'Connor; H B Quinton; N D Traven; L D Ramunno; T A Dodds; T A Marciniak; J E Wennberg Journal: JAMA Date: 1999-02-17 Impact factor: 56.272
Authors: Gary M Oderda; R Scott Evans; James Lloyd; Arthur Lipman; Connie Chen; Michael Ashburn; John Burke; Matthew Samore Journal: J Pain Symptom Manage Date: 2003-03 Impact factor: 3.612
Authors: M Soledad Cepeda; John T Farrar; Mona Baumgarten; Ray Boston; Daniel B Carr; Brian L Strom Journal: Clin Pharmacol Ther Date: 2003-08 Impact factor: 6.875
Authors: F Modarai; K Mack; P Hicks; S Benoit; S Park; C Jones; S Proescholdbell; A Ising; L Paulozzi Journal: Drug Alcohol Depend Date: 2013-02-08 Impact factor: 4.492
Authors: Peter Pronovost; Brad Weast; Mandalyn Schwarz; Rhonda M Wyskiel; Donna Prow; Shelley N Milanovich; Sean Berenholtz; Todd Dorman; Pamela Lipsett Journal: J Crit Care Date: 2003-12 Impact factor: 3.425
Authors: L Pilote; R M Califf; S Sapp; D P Miller; D B Mark; W D Weaver; J M Gore; P W Armstrong; E M Ohman; E J Topol Journal: N Engl J Med Date: 1995-08-31 Impact factor: 91.245
Authors: Joanne E Brady; Charles J DiMaggio; Katherine M Keyes; John J Doyle; Lynne D Richardson; Guohua Li Journal: Ann Epidemiol Date: 2015-04-02 Impact factor: 3.797
Authors: Shoshana J Herzig; Susan L Calcaterra; Hilary J Mosher; Matthew V Ronan; Nicole Van Groningen; Lili Shek; Anthony Loffredo; Michelle Keller; Anupam B Jena; Teryl K Nuckols Journal: J Hosp Med Date: 2018-04 Impact factor: 2.960
Authors: Eric L Garland; Anne K Baker; Paula Larsen; Michael R Riquino; Sarah E Priddy; Elizabeth Thomas; Adam W Hanley; Patricia Galbraith; Nathan Wanner; Yoshio Nakamura Journal: J Gen Intern Med Date: 2017-07-12 Impact factor: 5.128
Authors: Julie M Donohue; Jason N Kennedy; Christopher W Seymour; Timothy D Girard; Wei-Hsuan Lo-Ciganic; Catherine H Kim; Oscar C Marroquin; Patience Moyo; Chung-Chou H Chang; Derek C Angus Journal: Ann Intern Med Date: 2019-06-18 Impact factor: 25.391
Authors: Jo Ann Shoup; Shane R Mueller; Ingrid A Binswanger; Anna V Williams; John Strang; Jason M Glanz Journal: Pain Med Date: 2020-10-01 Impact factor: 3.750
Authors: Michael J Ward; Diwas Kc; Cathy A Jenkins; Dandan Liu; Amit Padaki; Jesse M Pines Journal: Am J Emerg Med Date: 2018-07-31 Impact factor: 2.469