Saint Peter's University Hospital/Rutgers-RWJ Medical School, New Brunswick, NJ, USA.
Saint Peter's University Hospital/Rutgers-RWJ Medical School, New Brunswick, NJ, USA.
Pancreatology. 2020 Jan;20(1):35-43. doi: 10.1016/j.pan.2019.11.004. Epub 2019 Nov 14.
The opioid epidemic in the United States has been on the rise. Acute exacerbations of chronic pancreatitis (AECP) patients are at higher risk for Opioid Use Disorder (OUD). Evidence on OUD's impact on healthcare utilization, especially hospital re-admissions is scarce. We measured the impact of OUD on 30-day readmissions, in patients admitted with AECP from 2010 to 2014.
This is a retrospective cohort study which included patients with concurrently documented CP and acute pancreatitis as first two diagnoses, from the National Readmissions Database (NRD). Pancreatic cancer patients and those who left against medical advice were excluded. We compared the 30-day readmission risk between OUD-vs.-non-OUD, while adjusting for other confounders, using multivariable exact-matched [(EM); 18 confounders; n = 28,389] and non-EM regression/time-to-event analyses.
189,585 patients were identified. 6589 (3.5%) had OUD. Mean age was 48.7 years and 57.5% were men. Length-of-stay (4.4 vs 3.9 days) and mean index hospitalization costs ($10,251 vs. $9174) were significantly higher in OUD-compared to non-OUD-patients (p < 0.001). The overall mean 30-day readmission rate was 27.3% (n = 51,806; 35.3% in OUD vs. 27.0% in non-OUD; p < 0.001). OUD patients were 25% more likely to be re-admitted during a 30-day period (EM-HR: 1.25; 95%CI: 1.16-1.36; p < 0.001), Majority of readmissions were pancreas-related (60%), especially AP. OUD cases' aggregate readmissions costs were $23.3 ± 1.5 million USD (n = 2289).
OUD contributes significantly to increased readmission risk in patients with AECP, with significant downstream healthcare costs. Measures against OUD in these patients, such as alternative pain-control therapies, may potentially alleviate such increase in health-care resource utilization.
美国的阿片类药物泛滥问题一直在加剧。慢性胰腺炎（CP）急性加重（AECP）患者发生阿片类药物使用障碍（OUD）的风险更高。关于 OUD 对医疗保健利用的影响，尤其是对医院再入院的影响，证据很少。我们测量了 OUD 对 2010 年至 2014 年期间因 AECP 入院的患者 30 天再入院的影响。
这是一项回顾性队列研究，纳入了国家再入院数据库（NRD）中同时记录有 CP 和急性胰腺炎作为前两个诊断的患者。排除了胰腺癌患者和未经医嘱离院的患者。我们比较了 OUD 与非 OUD 患者之间的 30 天再入院风险，同时使用多变量精确匹配（EM）[18 个混杂因素；n=28389]和非 EM 回归/时间事件分析进行调整。
共确定了 189585 名患者。6589 名（3.5%）患者患有 OUD。平均年龄为 48.7 岁，57.5%为男性。与非 OUD 患者相比，OUD 患者的住院时间（4.4 天 vs. 3.9 天）和平均住院费用（10251 美元 vs. 9174 美元）显著更高（p<0.001）。OUD 患者的总体 30 天再入院率为 27.3%（n=51806；35.3%在 OUD 中，27.0%在非 OUD 中；p<0.001）。在 30 天期间，OUD 患者再入院的可能性高 25%（EM-HR：1.25；95%CI：1.16-1.36；p<0.001），大多数再入院与胰腺相关（60%），尤其是急性胰腺炎。OUD 病例的总再入院费用为 2330 万美元（n=2289）。
OUD 显著增加了 AECP 患者的再入院风险，并导致大量医疗保健费用增加。针对这些患者的 OUD 措施，如替代疼痛控制疗法，可能会减轻这种医疗资源利用的增加。
