Department of Quality Management and Patient Safety, Beaumont Health, Southfield, MI (JLM); Substance Use Disorders Initiative, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, MA (SEW); School of Pharmacy, Northeastern University, Boston, MA (MSD); Department of Pharmacy, Massachusetts General Hospital, Boston, MA (RJR); Department of Health Sciences, Northeastern University, Boston, MA (JSJ); School of Pharmacy, Northeastern University, Boston, MA (JWD).
J Addict Med. 2019 Jul/Aug;13(4):306-313. doi: 10.1097/ADM.0000000000000499.
To identify the incidence, characteristics, and predictors for 30 and 90-day readmission among acutely hospitalized patients with opioid use disorder (OUD).
This retrospective, cohort study evaluated consecutive adults with OUD admitted to an academic medical center over a 5-year period (10/1/11 to 9/30/16). Multivariable logistic regression was used to determine independent predictors for 30 and 90-day readmissions based on pertinent admission, hospital, and discharge variables collected via chart review and found to be different (with a P < 0.10) on univariate analysis.
Among the 470 adults (mean age 43.1 ± 12.8 years, past heroin use 77.9%; admission opioid agonist therapy use [buprenorphine 22.6%; methadone 27.0%]; medical [vs surgical] admission 75.3%, floor [vs ICU] admission 93.0%, in-hospital mortality 0.9%), 85 (18.2%) and 151 (32.1%) were readmitted within 30 and 90 days, respectively. Among the 90-day readmitted patients, median time to first readmission was 26 days. Buprenorphine use (vs no use) at index hospital admission was independently associated with reduced 30-day (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.24-0.93) and 90-day (OR 0.57, 95% CI 0.34-0.96) readmission; prior heroin (vs prescription opioid) use was associated with reduced 90-day readmission (OR 0.59, 95% CI 0.37-0.94) and length of hospital stay was associated with both greater 30-day (OR 1.02, 95% CI 1.01-1.05) and 90-day (OR 1.04, 95% CI 1.01-1.06) readmission rates.
Among patients with OUD taking buprenorphine at the time of hospital admission, 30-day and 90-day hospital readmission was reduced by 53% and 43%, respectively.
确定在患有阿片类药物使用障碍（OUD）的急性住院患者中，30 天和 90 天再入院的发生率、特征和预测因素。
这项回顾性队列研究评估了在 5 年期间（2011 年 10 月 1 日至 2016 年 9 月 30 日）入住学术医疗中心的连续 OUD 成年患者。基于通过图表审查收集的相关入院、医院和出院变量，多变量逻辑回归用于确定 30 天和 90 天再入院的独立预测因素，并发现它们在单变量分析中存在差异（P<0.10）。
在 470 名成年人中（平均年龄 43.1±12.8 岁，过去使用海洛因 77.9%；入院时使用阿片类激动剂治疗[丁丙诺啡 22.6%；美沙酮 27.0%]；医疗[与手术]入院 75.3%，楼层[与 ICU]入院 93.0%，院内死亡率 0.9%），分别有 85（18.2%）和 151（32.1%）人在 30 天和 90 天内再次入院。在 90 天再入院的患者中，首次再入院的中位时间为 26 天。入院时使用丁丙诺啡（与未使用）与降低 30 天（比值比[OR]0.47，95%置信区间[CI]0.24-0.93）和 90 天（OR 0.57，95% CI 0.34-0.96）再入院独立相关；先前使用海洛因（与处方阿片类药物）与降低 90 天再入院相关（OR 0.59，95% CI 0.37-0.94），住院时间与 30 天（OR 1.02，95% CI 1.01-1.05）和 90 天（OR 1.04，95% CI 1.01-1.06）再入院率均增加相关。
在入院时使用丁丙诺啡的 OUD 患者中，30 天和 90 天的医院再入院率分别降低了 53%和 43%。
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