Division of Gastroenterology, Hepatology and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Division of Gastroenterology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Am J Gastroenterol. 2020 Sep;115(9):1474-1485. doi: 10.14309/ajg.0000000000000806.
Opioid use in patients with inflammatory bowel disease (IBD) is associated with increased mortality. Previous interventions targeting reduced intravenous opioid (IVOPI) exposure for all patients admitted to a general medical unit have decreased total opioid use without compromising pain control. We therefore performed a prospective evaluation of a multimodal intervention encouraging the use of nonopioid alternatives to reduce IVOPI exposure among patients with IBD hospitalized at our institution.
This was a prospective evaluation of a multimodal intervention to reduce IVOPI use among patients with IBD aged ≥18 years admitted to a general medical unit at a large urban academic medical center from January 1, 2019, to June 30, 2019. Intravenous and total (all routes) opioid exposures were measured as proportions and intravenous morphine milligram equivalents/patient day and compared with preintervention (January 1, 2018, to December 31, 2018) data. Hospital length of stay (LOS), 30-day readmission rates (RRs), and pain scores (1-10 scale) were also assessed.
Our study involved 345 patients with IBD with similar baseline characteristics in preintervention (n = 241) and intervention (n = 104) periods. Between study periods, we observed a significant reduction in the proportion of patients receiving IVOPIs (43.6% vs 30.8%, P = 0.03) and total opioid dose exposure (15.6 vs 8.5 intravenous morphine mg equivalents/d, P = 0.02). We observed similar mean pain scores (3.9 vs 3.7, P = 0.55) and significantly reduced mean LOS (7.2 vs 5.3 days, P = 0.03) and 30-day RRs (21.6% vs 11.5%, P = 0.03).
A multimodal intervention was associated with reduced opioid exposure, LOS, and 30-day RRs for hospitalized patients with IBD. Additional research is needed to determine long-term benefits of reduced opioid exposure in this population.
在炎症性肠病（IBD）患者中使用阿片类药物与死亡率增加有关。先前的干预措施旨在减少所有入住普通内科病房的患者的静脉内阿片类药物（IVOPI）暴露量，这些干预措施减少了总阿片类药物的使用，同时并未影响疼痛控制。因此，我们对一项多模式干预措施进行了前瞻性评估，该措施鼓励使用非阿片类药物替代物，以减少我院住院 IBD 患者的 IVOPI 暴露量。
这是对一项多模式干预措施的前瞻性评估，该措施旨在减少 2019 年 1 月 1 日至 2019 年 6 月 30 日期间入住大型城市学术医疗中心普通内科病房的年龄≥18 岁的 IBD 患者的 IVOPI 使用量。静脉内和总（所有途径）阿片类药物暴露量以比例和静脉内吗啡毫克当量/患者日来衡量，并与干预前（2018 年 1 月 1 日至 2018 年 12 月 31 日）的数据进行比较。还评估了住院时间（LOS）、30 天再入院率（RR）和疼痛评分（1-10 分）。
我们的研究涉及 345 名 IBD 患者，干预前（n=241）和干预后（n=104）期间的基线特征相似。在研究期间，我们观察到接受 IVOPI 治疗的患者比例（43.6% vs 30.8%，P=0.03）和总阿片类药物剂量暴露量（15.6 vs 8.5 静脉内吗啡 mg 当量/d，P=0.02）均显著降低。我们观察到相似的平均疼痛评分（3.9 vs 3.7，P=0.55）和显著缩短的平均 LOS（7.2 天 vs 5.3 天，P=0.03）和 30 天 RR（21.6% vs 11.5%，P=0.03）。
多模式干预与减少 IBD 住院患者的阿片类药物暴露、LOS 和 30 天 RR 相关。需要进一步研究以确定减少该人群中阿片类药物暴露的长期益处。
