Julie M Donohue1, Jason N Kennedy2, Christopher W Seymour2, Timothy D Girard2, Wei-Hsuan Lo-Ciganic3, Catherine H Kim4, Oscar C Marroquin2, Patience Moyo5, Chung-Chou H Chang6, Derek C Angus2. 1. University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania (J.M.D.). 2. University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (J.N.K., C.W.S., T.D.G., O.C.M., D.C.A.). 3. College of Pharmacy, University of Florida, Gainesville, Florida (W.L.). 4. UPMC Presbyterian Hospital, Pittsburgh, Pennsylvania (C.H.K.). 5. Brown University School of Public Health, Providence, Rhode Island (P.M.). 6. University of Pittsburgh School of Medicine and University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania (C.H.C.).
Abstract
Background: Patterns of inpatient opioid use and their associations with postdischarge opioid use are poorly understood. Objective: To measure patterns in timing, duration, and setting of opioid administration in opioid-naive hospitalized patients and to examine associations with postdischarge use. Design: Retrospective cohort study using electronic health record data from 2010 to 2014. Setting: 12 community and academic hospitals in Pennsylvania. Patients: 148 068 opioid-naive patients (191 249 admissions) with at least 1 outpatient encounter within 12 months before and after admission. Measurements: Number of days and patterns of inpatient opioid use; any outpatient use (self-report and/or prescription orders) 90 and 365 days after discharge. Results: Opioids were administered in 48% of admissions. Patients were given opioids for a mean of 67.9% (SD, 25.0%) of their stay. Location of administration of first opioid on admission, timing of last opioid before discharge, and receipt of nonopioid analgesics varied substantially. After adjustment for potential confounders, 5.9% of inpatients receiving opioids had outpatient use at 90 days compared with 3.0% of those without inpatient use (difference, 3.0 percentage points [95% CI, 2.8 to 3.2 percentage points]). Opioid use at 90 days was higher in inpatients receiving opioids less than 12 hours before discharge than in those with at least 24 opioid-free hours before discharge (7.5% vs. 3.9%; difference, 3.6 percentage points [CI, 3.3 to 3.9 percentage points]). Differences based on proportion of the stay with opioid use were modest (opioid use at 90 days was 6.4% and 5.4%, respectively, for patients with opioid use for ≥75% vs. ≤25% of their stay; difference, 1.0 percentage point [CI, 0.4 to 1.5 percentage points]). Associations were similar for opioid use 365 days after discharge. Limitation: Potential unmeasured confounders related to opioid use. Conclusion: This study found high rates of opioid administration to opioid-naive inpatients and associations between specific patterns of inpatient use and risk for long-term use after discharge. Primary Funding Source: UPMC Health System and University of Pittsburgh.
Background: Patterns of inpatient opioid use and their associations with postdischarge opioid use are poorly understood. Objective: To measure patterns in timing, duration, and setting of opioid administration in opioid-naive hospitalized patients and to examine associations with postdischarge use. Design: Retrospective cohort study using electronic health record data from 2010 to 2014. Setting: 12 community and academic hospitals in Pennsylvania. Patients: 148 068 opioid-naive patients (191 249 admissions) with at least 1 outpatient encounter within 12 months before and after admission. Measurements: Number of days and patterns of inpatient opioid use; any outpatient use (self-report and/or prescription orders) 90 and 365 days after discharge. Results: Opioids were administered in 48% of admissions. Patients were given opioids for a mean of 67.9% (SD, 25.0%) of their stay. Location of administration of first opioid on admission, timing of last opioid before discharge, and receipt of nonopioid analgesics varied substantially. After adjustment for potential confounders, 5.9% of inpatients receiving opioids had outpatient use at 90 days compared with 3.0% of those without inpatient use (difference, 3.0 percentage points [95% CI, 2.8 to 3.2 percentage points]). Opioid use at 90 days was higher in inpatients receiving opioids less than 12 hours before discharge than in those with at least 24 opioid-free hours before discharge (7.5% vs. 3.9%; difference, 3.6 percentage points [CI, 3.3 to 3.9 percentage points]). Differences based on proportion of the stay with opioid use were modest (opioid use at 90 days was 6.4% and 5.4%, respectively, for patients with opioid use for ≥75% vs. ≤25% of their stay; difference, 1.0 percentage point [CI, 0.4 to 1.5 percentage points]). Associations were similar for opioid use 365 days after discharge. Limitation: Potential unmeasured confounders related to opioid use. Conclusion: This study found high rates of opioid administration to opioid-naive inpatients and associations between specific patterns of inpatient use and risk for long-term use after discharge. Primary Funding Source: UPMC Health System and University of Pittsburgh.
Authors: Shobha Phansalkar; Qoua L Her; Alisha D Tucker; Esen Filiz; Jeffrey Schnipper; George Getty; David W Bates Journal: Am J Health Syst Pharm Date: 2015-02-01 Impact factor: 2.637
Authors: Marsha A Raebel; Sophia R Newcomer; Elizabeth A Bayliss; Denise Boudreau; Lynn DeBar; Thomas E Elliott; Ameena T Ahmed; Pamala A Pawloski; David Fisher; Sengwee Toh; William Troy Donahoo Journal: Pharmacoepidemiol Drug Saf Date: 2014-04-14 Impact factor: 2.890
Authors: Shepard P Johnson; Kevin C Chung; Lin Zhong; Melissa J Shauver; Michael J Engelsbe; Chad Brummett; Jennifer F Waljee Journal: J Hand Surg Am Date: 2016-09-28 Impact factor: 2.230
Authors: Susan L Calcaterra; Traci E Yamashita; Sung-Joon Min; Angela Keniston; Joseph W Frank; Ingrid A Binswanger Journal: J Gen Intern Med Date: 2016-05 Impact factor: 5.128
Authors: Gabriel A Brat; Denis Agniel; Andrew Beam; Brian Yorkgitis; Mark Bicket; Mark Homer; Kathe P Fox; Daniel B Knecht; Cheryl N McMahill-Walraven; Nathan Palmer; Isaac Kohane Journal: BMJ Date: 2018-01-17
Authors: Hannah Wunsch; Andrea D Hill; Longdi Fu; Rob A Fowler; Han Ting Wang; Tara Gomes; Eddy Fan; David N Juurlink; Ruxandra Pinto; Duminda N Wijeysundera; Damon C Scales Journal: Am J Respir Crit Care Med Date: 2020-08-15 Impact factor: 21.405
Authors: Iraklis E Tseregounis; Daniel J Tancredi; Susan L Stewart; Aaron B Shev; Andrew Crawford; James J Gasper; Garen Wintemute; Brandon D L Marshall; Magdalena Cerdá; Stephen G Henry Journal: Med Care Date: 2021-12-01 Impact factor: 2.983
Authors: Jessica B Rubin; Jennifer C Lai; Amy M Shui; Samuel F Hohmann; Andrew Auerbach Journal: J Clin Gastroenterol Date: 2021-10-14 Impact factor: 3.062
Authors: Luis E Tollinche; Kenneth P Seier; Gloria Yang; Kay See Tan; Yekaterina D Tayban; Stephen M Pastores; Cindy B Yeoh; Kunal Karamchandani Journal: J Crit Care Date: 2021-11-29 Impact factor: 4.298
Authors: Andrew W Roberts; Samantha Eiffert; Elizabeth M Wulff-Burchfield; Stacie B Dusetzina; Devon K Check Journal: J Natl Cancer Inst Date: 2021-04-06 Impact factor: 13.506
Authors: Stephen G Henry; Susan L Stewart; Eryn Murphy; Iraklis Erik Tseregounis; Andrew J Crawford; Aaron B Shev; James J Gasper; Daniel J Tancredi; Magdalena Cerdá; Brandon D L Marshall; Garen J Wintemute Journal: J Gen Intern Med Date: 2021-03-19 Impact factor: 5.128
Authors: Olena Mazurenko; Barbara T Andraka-Christou; Matthew J Bair; Areeba Y Kara; Christopher A Harle Journal: BMC Health Serv Res Date: 2020-06-08 Impact factor: 2.655