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Pain Med. 2018 Aug 21. doi: 10.1093/pm/pny150. [Epub ahead of print]

Overdose Risk Associated with Opioid Use upon Hospital Discharge in Veterans Health Administration Surgical Patients.

Author information

1
Anesthesiology and Perioperative Care Service.
2
Center for Innovation to Implementation.
3
Department of Anesthesiology, Perioperative and Pain Medicine.
4
Program Evaluation and Resource Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration.
5
Health Economics Resource Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
6
Department of Surgery.
7
Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.

Abstract

Objective:

To determine an association between opioid use upon hospital discharge (ongoing and newly started) in surgical patients and risks of opioid overdose and delirium for the first year.

Design:

Retrospective, cohort study.

Setting:

Population-level study of Veterans Health Administration patients.

Subjects:

All Veterans Health Administration patients (N = 64,391) who underwent surgery in 2011, discharged after one or more days, and without a diagnosis of opioid overdose or delirium from 90 days before admission through 30 days postdischarge (to account for additional opioid dosing in the context of chronic use).

Methods:

Patients' opioid use was categorized as 1) no opioids, 2) tramadol only, 3) short-acting only, 4) long-acting only, 5) short- and long-acting. We calculated unadjusted incidence rates and the incidence rate ratio (IRR) for opioid overdose and drug delirium for two time intervals: postdischarge days 0-30 and days 31-365. We then modeled outcomes of opioid overdose and delirium for postdischarge days 31-365 using a multivariable extended Cox regression model. Sensitivity analysis examined risk factors for overdose for postdischarge days 0-30.

Results:

Incidence of overdose was 11-fold greater from postdischarge days 0-30 than days 31-365: 26.3 events/person-year (N = 68) vs 2.4 events/person-year (N = 476; IRR = 10.80, 95% confidence interval [CI] = 8.37-13.92). Higher-intensity opioid use was associated with increasing risk of overdose for the year after surgery, with the highest risk for the short- and long-acting group (hazard ratio = 4.84, 95% CI = 3.28-7.14). Delirium (IRR = 10.66, 95% CI = 7.96-14.29) was also associated with higher opioid intensity.

Conclusions:

Surgical patients should be treated with the lowest effective intensity of opioids and be monitored to prevent opioid-related adverse events.

PMID:
30137452
DOI:
10.1093/pm/pny150

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