Limited research suggests an elevated risk of opioid use disorder (OUD) among patients with acute exacerbations of chronic pancreatitis (AECP), with OUD appearing to be associated with increased healthcare resource utilization in this patient population. However, with no national-level studies having done so, Paris Charilaou, MD, and colleagues conducted a retrospective cohort study to directly measure the impact of OUD on 30-day hospital readmissions in patients with concurrently documented CP and acute pancreatitis as their first two diagnoses who were admitted with AECP from 2010 to 2014. Results were published in Pancreatology.

A Nationwide Matched Analysis

“We leveraged the National Readmission Database (NRD), a unique and powerful database designed to support various types of analyses of national readmission rates,” explains Dr. Charilaou. “We used exact-matching analysis to neutralize to the best extent possible the effect of other potential factors that may contribute to the risk for readmission, hence ‘isolating’ the effect of OUD on readmissions.”

To that end, patients with pancreatic cancer and those who left against medical advice were excluded. The researchers compared 30-day readmission risk between patients with and without OUD. Among nearly 190,000 patients in the cohort, 3.5% had documented OUD, 57.5% were men, and the mean age was 48.7 years.

One in Three

“We observed that nearly one in three patients with OUD and AECP were readmitted within 30 days of index hospitalization for any cause,” says Dr. Devani. Patients with OUD also had lengths of stay (4.4 vs 3.9 days) and mean index hospitalization costs ($10,251 vs. $9,174) that were significantly higher than those of non-OUD patients. The overall mean 30-day readmission rate was 27.3% (35.3% in the OUD group, 27.0% in the non-OUD group).

“OUD status independently carried a 40% higher risk to be readmitted within 30-days, with a 25% increased risk after adjusting for time variation, when compared with non-OUD status (hazard ratio 1.25),” Dr. Devani notes. “Nearly 60% of these readmissions were for pancreas-related disorder and mostly ‘acute-on-chronic pancreatitis presentations,’ or more precisely, AECP. Patients with OUD patients also presented back to the hospital earlier, with an average 21% earlier presentation (time ratio 0.79). The aggregate cost of readmitted patients who carried documentation of OUD on their index admission was estimated at $23.3 million during the 5-year study period. Given that not all OUD is captured in administrative databases, we presume that this number is a minimum estimate, and hence represents a significant healthcare resource utilization burden.”

When looking at trends over the study period, Dr. Charilaou and colleagues found that OUD case prevalence rates in the study population increased from 2.9% in 2010 to 4.2% in 2014 (Figure). “While 30-day readmission rates have significantly decreased, both overall and in non-OUD patients, the trend was not statistically significant among OUD-patients, even after excluding the Year 2012,” adds Dr. Devani. “This could suggest that OUD may be preventing any significant decrease in the readmission rate in these patients by contributing to increasing readmissions, a finding consistent with our exact-matched analysis.”

Detrimental Vs Beneficial

The study results add to the body of evidence that chronic use of opioids in patients with chronic pancreatitis can be more detrimental than beneficial, both clinically and in terms of resource utilization, specifically 30-day readmission, according to Dr. Devani. “In the era of the opioid epidemic and rising healthcare costs, such findings are more relevant than ever,” she says. “We suggest that during the treatment of patients hospitalized for AECP, measures against opioid misuse/abuse and prevention of OUD development must be taken, including adherence to the latest guidelines in pain management for chronic pancreatitis; the American College of Gastroenterology’s latest guidelines on the management of chronic pancreatitis make it clear that ‘opiates may be considered to treat painful CP only in patients in whom all other reasonable therapeutic options have been exhausted.’ It is also important to have an even closer outpatient follow-up post-discharge for patients with OUD, as they are prone to earlier re-admissions.”

References

Opioid use disorder in admissions for acute exacerbations of chronic pancreatitis and 30-day readmission risk: A nationwide matched analysis

https://www.sciencedirect.com/science/article/abs/pii/S1424390319307677