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. 2014 Feb;9(2):73-81.
doi: 10.1002/jhm.2102. Epub 2013 Nov 13.

Opioid utilization and opioid-related adverse events in nonsurgical patients in US hospitals

Shoshana J Herzig  1 , Michael B Rothberg, Michael Cheung, Long H Ngo, Edward R Marcantonio
Affiliations

Opioid utilization and opioid-related adverse events in nonsurgical patients in US hospitals

Shoshana J Herzig et al. J Hosp Med. 2014 Feb.

Abstract

Background: Recent studies in the outpatient setting have demonstrated high rates of opioid prescribing and overdose-related deaths. Prescribing practices in hospitalized patients are unexamined.

Objective: To investigate patterns and predictors of opioid utilization in nonsurgical admissions to US hospitals, variation in use, and the association between hospital-level use and rates of severe opioid-related adverse events.

Design, setting, and patients: Adult nonsurgical admissions to 286 US hospitals.

Measurements: Opioid exposure and severe opioid-related adverse events during hospitalization, defined using hospital charges and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes.

Results: Of 1.14 million admissions, opioids were used in 51%. The mean ± standard deviation daily dose received in oral morphine equivalents was 68 ± 185 mg; 23% of exposed received a total daily dose of ≥100 mg oral morphine equivalents. Opioid-prescribing rates ranged from 5% in the lowest-prescribing hospital to 72% in the highest-prescribing hospital (mean, 51% ± 10%). After adjusting for patient characteristics, the adjusted opioid-prescribing rates ranged from 33% to 64% (mean, 50% ± standard deviation 4%). Among exposed, 0.60% experienced severe opioid-related adverse events. Hospitals with higher opioid-prescribing rates had higher adjusted relative risk of a severe opioid-related adverse event per patient exposed (relative risk: 1.23 [1.14-1.33] for highest-prescribing compared with lowest-prescribing quartile).

Conclusions: The majority of hospitalized nonsurgical patients were exposed to opioids, often at high doses. Hospitals that used opioids most frequently had increased adjusted risk of a severe opioid-related adverse event per patient exposed. Interventions to standardize and enhance the safety of opioid prescribing in hospitalized patients should be investigated.

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Conflict of interest statement

Disclosures: None of the authors have any conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Histograms of hospital opioid prescribing rate before (a) and after (b) adjustment for patient characteristics.
See this image and copyright information in PMC

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