Division of Gastroenterology, Hepatology, and Endoscopy, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Dig Dis Sci. 2020 Feb;65(2):611-614. doi: 10.1007/s10620-019-05799-w. Epub 2019 Aug 22.
Early readmissions in acute pancreatitis (AP) are common. The impact of opiate prescriptions on readmissions is unknown.
To determine whether the prescription of opiates at hospital discharge and the dose prescribed are associated with early readmissions in AP.
Direct admissions from the Emergency Department (ED) for AP from September 1, 2013, to August 31, 2016 were identified. Opiate prescription was defined as a new prescription at discharge in an opiate-naïve patient. Early readmission was ED visit or hospitalization within 30 days for an AP-related reason. Multivariable logistic regression was performed, adjusted for age, Charlson Comorbidity Index, pancreatic necrosis, baseline opiate use, non-opiate analgesics, and pain score at discharge.
A total of 318 AP patients were identified; the overall early readmission rate was 18%. One hundred and twenty-one (38%) were prescribed opiates at discharge, and 22% had an early readmission. One hundred and ninety-seven (62%) were not prescribed opiates, and 16% had an early readmission. Median opiate dose was 48 mg (24-h morphine equivalents). On multivariable analysis, neither the prescription of opiates (OR 1.2, 95% CI 0.6-2.4, p = 0.55) nor the dose of opiates (OR 0.99, 95% CI 0.99-1.00, p = 0.39) was associated with early readmission. In subset analysis of patients discharged with an opiate prescription, those on opiates at baseline were significantly more likely to have an early readmission (OR 4.19, 95% CI 1.04-16.94, p = 0.04).
In AP patients, neither prescription of opiates at discharge nor prescribed dose was associated with early readmission. Patients on opiates at baseline discharged with an opiate prescription were more likely to have an early readmission.
急性胰腺炎（AP）的早期再入院较为常见。阿片类药物的处方对再入院的影响尚不清楚。
确定出院时阿片类药物的开具情况及其剂量与 AP 的早期再入院是否相关。
确定 2013 年 9 月 1 日至 2016 年 8 月 31 日从急诊科直接收治的 AP 患者。阿片类药物处方定义为阿片类药物初治患者出院时的新处方。早期再入院是指因 AP 相关原因在 30 天内进行 ED 就诊或住院。进行多变量逻辑回归分析，调整年龄、Charlson 合并症指数、胰腺坏死、基线阿片类药物使用、非阿片类镇痛药和出院时疼痛评分等因素。
共确定 318 例 AP 患者，总体早期再入院率为 18%。121 例（38%）患者出院时开具了阿片类药物，22%的患者发生早期再入院。197 例（62%）患者未开具阿片类药物，16%的患者发生早期再入院。阿片类药物的中位剂量为 48mg（24 小时吗啡当量）。多变量分析显示，阿片类药物的开具（比值比 1.2，95%置信区间 0.6-2.4，p=0.55）和阿片类药物的剂量（比值比 0.99，95%置信区间 0.99-1.00，p=0.39）均与早期再入院无关。在出院时开具阿片类药物的患者亚组分析中，基线时使用阿片类药物的患者发生早期再入院的可能性显著更高（比值比 4.19，95%置信区间 1.04-16.94，p=0.04）。
在 AP 患者中，出院时开具阿片类药物和开具剂量均与早期再入院无关。出院时开具阿片类药物且基线时使用阿片类药物的患者发生早期再入院的可能性更高。
