A Journal of Hospital Medicine study billed as the first of its kind found that patients who had received chronic opioid therapy (COT) in the six months prior to admission were more likely to either die in the hospital within 30 days or be readmitted.
The report, "Prevalence and Characteristics of Hospitalized Adults on Chronic Opioid Therapy," found that after adjustments, COT was associated with higher rates of hospital readmission (odds ratio [OR]: 1.15, 95% confidence interval [CI]: 1.10–1.20) and death (OR: 1.19, 95% CI: 1.10–1.29). The observational study—conducted on veterans with acute medical conditions admitted to Veterans Administration hospitals between 2009 and 2011—found that 25.9% had received COT in the six months prior to admission.
Hospitalist and lead author Hilary Mosher, MD, of the Iowa City Veterans Affairs Health Care System in Des Moines, says that as COT use increases and the HM model expands, hospitalists should know more about how to treat these patients. "I can't imagine being a hospitalist practicing anywhere in the United States and not seeing these patients on a fairly regular basis," she adds.
Dr. Mosher says hospitalists could view COT similar to diabetes: while chronic pain is a condition managed primarily on an outpatient basis, hospitalists might see better outcomes if they address it as a condition that "affects how we care for patients during the inpatient stay." To that end, she is surprised that this study is the first to report the prevalence of, and characteristics associated with, prior opioid use among inpatients.
"We can't make claims [from this study] to answer [the question of] if we are over-treating or under-treating pain during the hospital stay," Dr. Mosher adds. "One of the really interesting things I'm looking forward to finding out is how will people respond to the idea that...chronic pain is a disease where what we do during the hospital stay matters to the eventual course."