Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
J Hosp Med. 2014 Feb;9(2):82-7. doi: 10.1002/jhm.2113. Epub 2013 Dec 6.
As chronic opioid therapy (COT) becomes more common, complexity of pain management in the inpatient setting increases; little is known about medical inpatients on COT.
To determine the prevalence of COT among hospitalized patients and to compare outcomes among these patients relative to those not receiving COT.
Observational study of inpatient and outpatient administrative data.
All veterans with acute medical admissions to 129 Veterans Administration hospitals during fiscal years 2009 to 2011, residing in the community, and with outpatient pharmacy use.
We defined COT as 90 or more days of opioids prescribed in the 6 months prior to hospitalization. Patient characteristics included demographic variables and major comorbidities. Outcomes included 30-day readmission and death during hospitalization or within 30 days, with associations ascertained using multivariable logistic regression.
Of 122,794 hospitalized veterans, 31,802 (25.9%) received COT. These patients differed from comparators in age, sex, race, residence, and presence of chronic noncancer pain, chronic obstructive pulmonary disease, complicated diabetes, cancer, and mental health diagnoses including post-traumatic stress disorder. After adjustment for demographic factors, comorbidities, and admission diagnosis, COT was associated with hospital readmission (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.10-1.20) and death (OR: 1.19, 95% CI: 1.10-1.29).
COT is common among medical inpatients. Patients on COT differ from patients without COT beyond dissimilarities in pain and cancer diagnoses. Occasional and chronic opioid use are associated with increased risk of hospital readmission, and COT is associated with increased risk of death. Additional research relating COT to hospitalization outcomes is warranted.
随着慢性阿片类药物治疗（COT）变得越来越普遍，住院患者的疼痛管理变得更加复杂；对于接受 COT 的住院患者，知之甚少。
确定住院患者中 COT 的患病率，并比较这些患者与未接受 COT 的患者的结局。
对住院和门诊行政数据进行观察性研究。
2009 年至 2011 年期间，居住在社区并在外用药房使用药物的所有接受急性医疗入院的退伍军人，共 129 家退伍军人事务部医院。
我们将 COT 定义为在住院前 6 个月内开具 90 天或以上的阿片类药物。患者特征包括人口统计学变量和主要合并症。结局包括住院期间或出院后 30 天内的 30 天再入院和死亡，使用多变量逻辑回归确定关联。
在 122794 名住院退伍军人中，有 31802 名（25.9%）接受了 COT。这些患者在年龄、性别、种族、居住地以及患有慢性非癌性疼痛、慢性阻塞性肺疾病、复杂糖尿病、癌症和心理健康诊断（包括创伤后应激障碍）方面与对照组不同。在调整人口统计学因素、合并症和入院诊断后，COT 与医院再入院（优势比 [OR]：1.15，95%置信区间 [CI]：1.10-1.20）和死亡（OR：1.19，95% CI：1.10-1.29）相关。
COT 在住院患者中很常见。接受 COT 的患者与未接受 COT 的患者在疼痛和癌症诊断之外存在差异。偶尔和慢性使用阿片类药物与住院再入院风险增加相关，而 COT 与死亡风险增加相关。需要进一步研究 COT 与住院结局的关系。
