College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Division of Pharmaceutical and Nutrition Care, Nebraska Medicine, Nebraska Medical Center, Omaha, Nebraska, USA.
Intern Med J. 2024 Oct;54(10):1644-1651. doi: 10.1111/imj.16467. Epub 2024 Jul 10.
Alcohol use disorder (AUD) is a persistent public health concern, contributing significantly to mortality and morbidity. This study aims to evaluate the impact of in-hospital extended-release naltrexone (XR-NTX) administration on alcohol-related outcomes.
This retrospective cohort study, conducted at an academic medical centre, included 141 adult patients with AUD who received XR-NTX between December 2020 and June 2021. Primary and secondary outcomes were assessed 90 days before and after XR-NTX administration to identify number of alcohol-related hospitalisations, emergency department (ED) visits and average length of hospital stay. Subgroup analyses assessed outcomes in high hospital utilisers and marginally housed or unhoused populations.
There was a significant decrease in ED visits and length of hospital stay post XR-NTX and no significant difference in the number of rehospitalisations. Subgroup analysis showed significant reduction in hospital readmissions and ED visits among high hospital utilisers. Our sample was a predominantly middle-aged, male and white patient population.
In-hospital initiation of XR-NTX for AUD was associated with a significant decrease in ED visits and length of hospital stay. While no significant impact on the number of hospitalisations was observed overall, there was a substantial reduction in hospital readmissions and ED visits among high utilisers. Our findings suggest the potential benefits of in-hospital XR-NTX, emphasising the need for further research to establish causal relationships, assess cost-effectiveness and explore effectiveness across diverse patient populations. Effective in-hospital interventions, such as XR-NTX, hold promise for improving patient outcomes and reducing the healthcare burden associated with AUD.
酒精使用障碍（AUD）是一个持续存在的公共卫生问题，对死亡率和发病率有重大影响。本研究旨在评估医院内给予延长释放型纳曲酮（XR-NTX）对酒精相关结局的影响。
这项回顾性队列研究在一家学术医疗中心进行，纳入了 2020 年 12 月至 2021 年 6 月期间接受 XR-NTX 的 141 例成人 AUD 患者。主要和次要结局在 XR-NTX 给药前 90 天和后 90 天进行评估，以确定与酒精相关的住院次数、急诊部（ED）就诊次数和平均住院时间。亚组分析评估了高住院利用率者以及有边缘住房或无住房人群的结局。
XR-NTX 后 ED 就诊次数和住院时间明显减少，而再住院次数无显著差异。亚组分析显示，高住院利用率者的住院再入院率和 ED 就诊次数显著减少。我们的样本主要是中年、男性和白人患者群体。
AUD 患者在医院内开始使用 XR-NTX 与 ED 就诊次数和住院时间的明显减少相关。虽然总体上观察到住院次数没有显著影响，但高利用率者的住院再入院率和 ED 就诊次数有实质性减少。我们的发现表明医院内 XR-NTX 的潜在益处，强调需要进一步研究以确定因果关系、评估成本效益并探索在不同患者群体中的有效性。有效的医院内干预措施，如 XR-NTX，有望改善患者结局并减轻 AUD 相关的医疗保健负担。
