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阿片类药物使用障碍与血管阻塞性危象中医疗相关结局的相关性。

The Associations Between Opioid Use Disorder and Healthcare-Related Outcomes in Vaso-occlusive Crisis.

机构信息

Department of Medicine, Hennepin Healthcare, Minneapolis, MN, USA.

Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.

出版信息

J Gen Intern Med. 2024 Jul;39(9):1666-1672. doi: 10.1007/s11606-024-08717-7. Epub 2024 Mar 18.

Abstract

BACKGROUND

In patients who experience frequent vaso-occlusive crises (VOC), opioid dependence may be due to a need for pain control as opposed to addiction; the implications of opioid use disorder (OUD) in this population are unclear.

OBJECTIVE

To compare outcomes in hospitalizations for VOC in those with a history of OUD to those without a history of OUD.

DESIGN

A retrospective assessment of hospitalizations for adults in the USA with a primary discharge diagnosis of VOC using the National Inpatient Sample database from 2016 to 2019. We also compared VOC hospitalizations to hospitalizations for all other reasons to assess differences in OUD-associated clinical factors.

PARTICIPANTS

In total, 273,460 hospitalizations for VOC; 23,120 (8.5%) of these hospital stays involved a secondary diagnosis of OUD.

MAIN MEASURES

Primary outcomes were length of hospital stay and cost. Mortality was a secondary outcome.

KEY RESULTS

Hospital length of stay was increased (mean 6.2 vs 4.9 days) in patients with OUD (adjusted rate ratio = 1.24, 95% CI 1.20-1.29, p < 0.001). Mean cost was also higher in those with OUD ($9076) than those without OUD ($8020, p < 0.001). Mortality was decreased in VOC hospitalizations in those with OUD, but the difference was not statistically significant (adjusted OR = 0.64, 95% CI 0.028-1.48, p = 0.30).

CONCLUSIONS

OUD is associated with increased length of stay and costs in patients with VOC. While there are many possible explanations, providers should consider undertreatment of pain due to addiction concerns as a potential factor; individualized pain plans to mitigate this challenge could be explored.

摘要

背景

在经常发生血管阻塞性危象(VOC)的患者中,阿片类药物依赖可能是由于需要控制疼痛而不是成瘾;在这一人群中,阿片类药物使用障碍(OUD)的影响尚不清楚。

目的

比较有 OUD 病史和无 OUD 病史的患者因 VOC 住院的结果。

设计

使用 2016 年至 2019 年国家住院患者样本数据库,对美国成年人因主要出院诊断为 VOC 的住院情况进行回顾性评估。我们还将 VOC 住院与因其他所有原因住院进行比较,以评估与 OUD 相关的临床因素差异。

参与者

共 273460 例 VOC 住院患者;其中 23120 例(8.5%)的住院治疗有 OUD 二级诊断。

主要测量指标

主要结局为住院时间和费用。死亡率是次要结局。

主要结果

OUD 患者的住院时间延长(平均 6.2 天比 4.9 天)(调整后率比 1.24,95%CI 1.20-1.29,p<0.001)。OUD 患者的平均费用也更高(9076 美元),而无 OUD 患者为 8020 美元(p<0.001)。在有 OUD 的 VOC 住院患者中,死亡率降低,但差异无统计学意义(调整后 OR 0.64,95%CI 0.028-1.48,p=0.30)。

结论

OUD 与 VOC 患者的住院时间延长和费用增加有关。虽然有许多可能的解释,但提供者应考虑因成瘾问题而导致的疼痛治疗不足可能是一个潜在因素;可以探索制定个体化的疼痛计划来缓解这一挑战。

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