Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2019 Apr 5;2(4):e191827.
doi: 10.1001/jamanetworkopen.2019.1827.

Factors Associated With Opioid Use in Patients Hospitalized for Acute Pancreatitis

Bechien U Wu  1 , Rebecca K Butler  2 , Wansu Chen  2
Affiliations
Observational Study

Factors Associated With Opioid Use in Patients Hospitalized for Acute Pancreatitis

Bechien U Wu et al. JAMA Netw Open. .

Abstract

Importance: Limited guidance exists regarding the optimal approach to management of pain in acute pancreatitis (AP).

Objectives: To investigate sources of variability in opioid use for treatment of acute pain in patients hospitalized for AP and to explore a potential association of opioid prescribing patterns with length of stay.

Design, setting, and participants: This retrospective cohort study included 4307 patients 18 years and older hospitalized for AP in a community-based integrated health care system, from January 1, 2008, to June 30, 2015. Analysis began in November 2017.

Exposures: Opioid use was quantified by morphine equivalent dose (MED).

Main outcomes and measures: Three analyses were performed: (1) factors associated with increased opioid administration during the initial 12 hours of hospitalization (baseline), (2) association of baseline opioid use with length of stay, and (3) frequency of opioid use 90 days after hospital discharge (persistent use).

Results: The cohort included 4307 patients (median [interquartile range] age, 57.4 [44.0-70.2] years; 2241 women [52.0%]) with AP. At baseline, 3443 patients (79.9%) received opioids, and 388 patients (9.6%) had persistent opioid use after discharge. After adjusting for pain and other clinical factors, women received less MED than men (adjusted event ratio, 0.83; 95% CI, 0.79-0.86; P < .001). Hispanic and Asian patients received less MED than non-Hispanic white patients (adjusted event ratio, 0.85; 95% CI, 0.81-0.90; P < .001; and adjusted event ratio, 0.79; 95% CI, 0.72-0.86; P < .001, respectively). Alcohol-related AP etiology was associated with increased MED vs gallstone disorders (adjusted event ratio, 1.11; 95% CI, 1.05-1.18; P < .001). Two of 13 hospitals administered significantly less opioids compared with the others. Median (interquartile range) length of stay was independently associated with MED at baseline, with 3.0 (2.1-4.5) days among patients not receiving opioids vs 5.0 (3.2-8.7) days among patients in the highest quintile of MED (P < .001).

Conclusions and relevance: In addition to pain and disease severity, opioid use varied by etiology of AP, sex, race/ethnicity, and institution of treatment. Increased opioid use at baseline was associated with longer hospitalization. These findings suggest opportunities for improved approaches to pain control for patients with AP.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Flow Diagram of Study Cohort
Figure 2.
Figure 2.. Event Ratio of Expected Morphine Equivalent Dose and 95% CI
NA indicates not applicable; SIRS, systemic inflammatory response syndrome.
See this image and copyright information in PMC

Comment in

References

    1. Peery AF, Crockett SD, Barritt AS, et al. . Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149(7):-. doi:10.1053/j.gastro.2015.08.045 - DOI - PMC - PubMed
    1. Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144(6):1252-1261. doi:10.1053/j.gastro.2013.01.068 - DOI - PMC - PubMed
    1. Sellers ZM, MacIsaac D, Yu H, et al. . Nationwide trends in acute and chronic pancreatitis among privately insured children and non-elderly adults in the United States, 2007-2014. Gastroenterology. 2018;155(2):469-478.e1. doi:10.1053/j.gastro.2018.04.013 - DOI - PMC - PubMed
    1. Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN; American Gastroenterological Association Institute Clinical Guidelines Committee . American Gastroenterological Association Institute guideline on initial management of acute pancreatitis. Gastroenterology. 2018;154(4):1096-1101. doi:10.1053/j.gastro.2018.01.032 - DOI - PubMed
    1. Tenner S, Baillie J, DeWitt J, Vege SS; American College of Gastroenterology . American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400-1415, 1416. doi:10.1038/ajg.2013.218 - DOI - PubMed

Publication types

MeSH terms

Substances