In inpatients with cirrhosis opioid use is common and associated with length of stay and persistent use post-discharge

Abstract

Background: Previous studies have demonstrated that opioids are often prescribed and associated with complications in outpatients with cirrhosis. Less is known about opioids among hospitalized patients with cirrhosis. We aimed to describe the patterns and complications of opioid use among inpatients with cirrhosis.

Methods: This retrospective cohort study included adult patients with cirrhosis admitted to a single hospital system from 4/4/2014 to 9/30/2015. We excluded hospitalizations with a surgery, invasive procedure, or palliative care/hospice consult in order to understand opioid use that may be avoidable. We determined the frequency, dosage, and type of opioids given during hospitalization. Using bivariable and multivariable analyses, we assessed length of stay, intensive care unit transfer, and in-hospital mortality by opioid use.

Results: Of 217 inpatients with cirrhosis, 118 (54.4%) received opioids during hospitalization, including 41.7% of patients without prior outpatient opioid prescriptions. Benzodiazepines or hypnotic sleep aids were given to 28.8% of opioid recipients. In the multivariable model, younger age and outpatient opioid prescription were associated with inpatient opioids. Hospitalization was longer among opioid recipients (median 3.9 vs 3.0 days, p = 0.002) and this difference remained after adjusting for age, cirrhosis severity, and medical comorbidities. There was no difference in intensive care unit transfers and no deaths occurred. At discharge, 22 patients were newly started on opioids of whom 10 (45.5%) had opioid prescriptions at 90 days post-discharge.

Conclusion: In non-surgical inpatients with cirrhosis, opioid prescribing was common and associated with prolonged length of stay. A high proportion of patients newly discharged with opioid prescriptions had ongoing prescriptions at 90 days post-discharge.

Fig 1. Flow diagram of inpatient cohort.

Flow diagram demonstrating the number of patients with cirrhosis admitted to the University of North Carolina (UNC) hospitals during the study period and the numbers included in the analysis after excluding recent surgeries or invasive procedures or hospice/palliative care/comfort care consultations. Among those included in the final cohort, the proportion receiving opioids stratified by outpatient opioid prescription is shown. Lastly, the number of patients discharged on opioids is demonstrated.

Fig 2. Histogram of average daily opioid use stratified by outpatient prescription of opioids.

Histogram demonstrating the frequency of patients by the average morphine milligram equivalent (MME) per day among patients with and without an outpatient opioid prescription. The numerator is the total summed dose, converted into morphine equivalents, divided by the total length of hospitalization; patients on patient controlled analgesia were considered in the highest quartile.