Shaikh Amjad, Khrais Ayham, Le Alexander, Kaye Alexander J, Ahlawat Sushil
Department of Medicine, Rutgers University New Jersey Medical School, Newark, USA.
Department of Gastroenterology and Hepatology, Rutgers University New Jersey Medical School, Newark, USA.
Cureus. 2023 Feb 4;15(2):e34624. doi: 10.7759/cureus.34624. eCollection 2023 Feb.
Background and objective Diverticulitis occurs in 10-25% of patients with diverticulosis. Although opioids can decrease bowel motility, there is scarce data on the effect of chronic opioid use on the outcomes of diverticulitis. In this study, we aimed to explore the outcomes of diverticulitis in patients with pre-existing opioid use. Methods Data between 2008 and 2014 from the National Inpatient Sample (NIS) database was extracted using the International Classification of Diseases, 9th Revision (ICD-9) codes. Univariate and multivariate analyses were used to generate odds ratios (OR). Elixhauser Comorbidity Index (ECI) scores predicting mortality and readmission were calculated based on weighted scores from 29 different comorbidities. Scores were compared between the two groups using univariate analysis. Inclusion criteria included patients with a primary diagnosis of diverticulitis. Exclusion criteria included patients less than 18 years of age, and a diagnosis of opioid use disorder in remission. Studied outcomes included inpatient mortality, complications (including perforation, bleeding, sepsis event, ileus, abscess, obstruction, and fistula), length of hospital stay, and total costs. Results A total of 151,708 patients with diverticulitis and no active opioid use and 2,980 patients with diverticulitis and active opioid use were hospitalized in the United States from 2008 to 2014. Opioid users had a higher OR for bleeding, sepsis, obstruction, and fistula formation. Opioid users had a lower risk of developing abscesses. They had longer lengths of stay, higher total hospital charges, and higher Elixhauser readmission scores. Conclusion Hospitalized diverticulitis patients with comorbid opioid use are at an elevated risk of in-hospital mortality and sepsis. This could be attributed to complications from injection drug use predisposing opioid users to these risk factors. Outpatient providers caring for patients with diverticulosis should consider screening their patients for opioid use and try offering them medication-assisted treatment to reduce their risk of poor outcomes.
憩室炎发生于10%至25%的憩室病患者中。尽管阿片类药物可降低肠道蠕动，但关于长期使用阿片类药物对憩室炎结局影响的数据却很少。在本研究中，我们旨在探讨已有阿片类药物使用史的患者发生憩室炎的结局。方法：利用国际疾病分类第九版（ICD - 9）编码，从国家住院患者样本（NIS）数据库中提取2008年至2014年的数据。采用单因素和多因素分析生成比值比（OR）。基于29种不同合并症的加权分数计算预测死亡率和再入院率的埃利克斯豪泽合并症指数（ECI）评分。使用单因素分析比较两组的评分。纳入标准包括原发性诊断为憩室炎的患者。排除标准包括年龄小于18岁的患者以及处于缓解期的阿片类药物使用障碍诊断患者。研究结局包括住院死亡率、并发症（包括穿孔、出血、脓毒症事件、肠梗阻、脓肿、梗阻和瘘管）、住院时间和总费用。结果：2008年至2014年期间，美国共有151,708例无阿片类药物使用且患憩室炎的患者以及2,980例有阿片类药物使用且患憩室炎的患者住院。阿片类药物使用者发生出血、脓毒症、梗阻和瘘管形成的OR值更高。阿片类药物使用者发生脓肿的风险较低。他们的住院时间更长、总住院费用更高且埃利克斯豪泽再入院评分更高。结论：合并阿片类药物使用的住院憩室炎患者院内死亡和脓毒症风险升高。这可能归因于注射吸毒引起的并发症使阿片类药物使用者易患这些风险因素。护理憩室病患者的门诊医护人员应考虑对患者进行阿片类药物使用筛查，并尝试为他们提供药物辅助治疗以降低不良结局风险。
