The Impact of Opioid Epidemic Trends on Hospitalized Acute Pancreatitis Patients

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Gastrointestinal Endoscopy


Introduction: Opioid use disorder (OUD) has become a public health crisis in the United States. OUD has been shown to have worse outcomes in patients with chronic conditions. Although opioids are widely used for pain management in acute conditions such as acute pancreatitis (AP), the impact of OUD on outcomes in patients with AP remains unknown. We aimed to evaluate the prevalence, trends and impact of OUD on outcomes in hospitalized patients with AP. Methods: This was a retrospective cohort study using the national inpatient sample (NIS) database from 2005-2014. Patients with a primary diagnosis of AP and OUD-related diagnosis were included. OUD-related diagnosis were identified using previously published studies. The primary outcome was to evaluate the prevalence and trend of OUD in hospitalized AP patients over time. Secondary outcomes were to assess the impact of OUD: i) in-hospital mortality, and ii) healthcare resource utilization (length of stay and total hospitalization costs). We used a multivariable regression analysis to adjust for potential confounders. Results: A total of 2,593,831 patients were hospitalized with AP from 2005-2014, out of which 37,829 (1.5%) had concomitant diagnosis of OUD. The prevalence of OUD in AP has doubled over the last decade from 1% in 2005 to 2.1% in 2014 [Figure 1]. After adjusting for potential confounders, AP patients with OUD had increased odds of in-hospital mortality [aOR: 1.4, (95 % CI: 1.2 – 1.7, P<0.001)]. Patients with AP who had OUD were found to have significantly higher adjusted mean length of stay (adjusted mean difference: 1.3 days, (95% CI: 1.3-1.4), P<0.001) and total hospitalization cost (adjusted mean difference: $2353, (95% CI: 2179-2508), p<0.001) [Table 1]. Conclusions: OUD is an independent predictor of mortality and increased healthcare resource utilization in patients hospitalized with AP. The opioid epidemic is not only leading to worse outcomes in patients with chronic medical conditions as previously thought, but these patients also have worse outcomes when hospitalized for an acute pathology such as acute pancreatitis. Opioids should be prescribed judiciously in patients with acute pancreatitis upon discharge from the hospital.