Julie M. Donohue, PhD; Jason N. Kennedy, MS; Christopher W. Seymour, MD, MSc; Timothy D. Girard, MD, MSCI; Wei-Hsuan Lo-Ciganic, MSPharm, PhD; Catherine H. Kim, PharmD, BCPS, BCCCP; Oscar C. Marroquin, MD; Patience Moyo, PhD; Chung-Chou H. Chang, PhD; Derek C. Angus, MD, MPH
Financial Support: By the UPMC Health System and the University of Pittsburgh.
Disclosures: Dr. Seymour reports a grant from the National Institutes of Health during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-2864.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that her spouse has stock options/holdings with Targeted Diagnostics and Therapeutics. Darren B. Taichman, MD, PhD, Executive Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Catharine B. Stack, PhD, MS, Deputy Editor, Statistics, reports that she has stock holdings in Pfizer, Johnson & Johnson, and Colgate-Palmolive. Christina C. Wee, MD, MPH, Deputy Editor, reports employment with Beth Israel Deaconess Medical Center. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Yu-Xiao Yang, MD, MSCE, Deputy Editor, reports that he has no financial relationships or interest to disclose.
Reproducible Research Statement:Study protocol and data set: Not available. Statistical code: Available from Dr. Donohue (e-mail, firstname.lastname@example.org).
Corresponding Author: Julie M. Donohue, PhD, Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, A635, 130 DeSoto Street, Pittsburgh, PA 15261; e-mail, email@example.com.
Current Author Addresses: Dr. Donohue: Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, A635, 130 DeSoto Street, Pittsburgh, PA 15261.
Mr. Kennedy: Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 640B Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261.
Drs. Seymour, Girard, and Angus: Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261.
Dr. Lo-Ciganic: Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, PO Box 100496, Gainesville, FL 32610-0496.
Dr. Kim: Department of Pharmacy, UPMC Presbyterian Hospital, 200 Lothrop Street, Pittsburgh, PA 15213.
Dr. Marroquin: UPMC Health Services Division and Department of Medicine, Department of Clinical Analytics, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261.
Dr. Moyo: Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Providence, RI 02912.
Dr. Chang: Department of Medicine, Department of Biostatistics, University of Pittsburgh School of Medicine, 300 Parkvale Building, 200 Meyran Avenue, Pittsburgh, PA 15213.
Author Contributions: Conception and design: J.M. Donohue, J. Kennedy, C.W. Seymour, W.H. Lo-Ciganic, C.H. Kim, D.C. Angus.
Analysis and interpretation of the data: J.M. Donohue, J. Kennedy, C.W. Seymour, T.D. Girard, W.H. Lo-Ciganic, C.C.H. Chang, D.C. Angus.
Drafting of the article: J.M. Donohue, J. Kennedy, D.C. Angus.
Critical revision of the article for important intellectual content: J. Kennedy, C.W. Seymour, T.D. Girard, W.H. Lo-Ciganic, O.C. Marroquin, P. Moyo, D.C. Angus.
Final approval of the article: J.M. Donohue, J. Kennedy, C.W. Seymour, T.D. Girard, W.H. Lo-Ciganic, C.H. Kim, O.C. Marroquin, P. Moyo, C.C.H. Chang, D.C. Angus.
Statistical expertise: J. Kennedy, C.W. Seymour, W.H. Lo-Ciganic, C.C.H. Chang.
Administrative, technical, or logistic support: J.M. Donohue, J. Kennedy, C.W. Seymour, D.C. Angus.
Collection and assembly of data: J. Kennedy, C.W. Seymour, O.C. Marroquin.
Patterns of inpatient opioid use and their associations with postdischarge opioid use are poorly understood.
To measure patterns in timing, duration, and setting of opioid administration in opioid-naive hospitalized patients and to examine associations with postdischarge use.
Retrospective cohort study using electronic health record data from 2010 to 2014.
12 community and academic hospitals in Pennsylvania.
148 068 opioid-naive patients (191 249 admissions) with at least 1 outpatient encounter within 12 months before and after admission.
Number of days and patterns of inpatient opioid use; any outpatient use (self-report and/or prescription orders) 90 and 365 days after discharge.
Opioids were administered in 48% of admissions. Patients were given opioids for a mean of 67.9% (SD, 25.0%) of their stay. Location of administration of first opioid on admission, timing of last opioid before discharge, and receipt of nonopioid analgesics varied substantially. After adjustment for potential confounders, 5.9% of inpatients receiving opioids had outpatient use at 90 days compared with 3.0% of those without inpatient use (difference, 3.0 percentage points [95% CI, 2.8 to 3.2 percentage points]). Opioid use at 90 days was higher in inpatients receiving opioids less than 12 hours before discharge than in those with at least 24 opioid-free hours before discharge (7.5% vs. 3.9%; difference, 3.6 percentage points [CI, 3.3 to 3.9 percentage points]). Differences based on proportion of the stay with opioid use were modest (opioid use at 90 days was 6.4% and 5.4%, respectively, for patients with opioid use for ≥75% vs. ≤25% of their stay; difference, 1.0 percentage point [CI, 0.4 to 1.5 percentage points]). Associations were similar for opioid use 365 days after discharge.
Potential unmeasured confounders related to opioid use.
This study found high rates of opioid administration to opioid-naive inpatients and associations between specific patterns of inpatient use and risk for long-term use after discharge.
UPMC Health System and University of Pittsburgh.
Donohue JM, Kennedy JN, Seymour CW, et al. Patterns of Opioid Administration Among Opioid-Naive Inpatients and Associations With Postdischarge Opioid Use: A Cohort Study. Ann Intern Med. 2019;171:81–90. [Epub ahead of print 18 June 2019]. doi: https://doi.org/10.7326/M18-2864
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Published: Ann Intern Med. 2019;171(2):81-90.
Published at www.annals.org on 18 June 2019
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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