Opioid Utilization in Hospitalized Patients With Cirrhosis

A retrospective cohort study found that patients with cirrhosis were more likely to receive opioids than non-opioid alternatives. These findings were published in the Journal of Clinical Gastroenterology.

Data were sourced from the Vizient Clinical Data Base/Resource Manager (CDB/RM) which is a consortium of 3,000 hospitals in the United States. Hospital discharges between 2017 and 2018 at 205 centers were reviewed for analgesic use among patients with cirrhosis (n=116,363) and matched noncirrhotic controls (n=116,363).

The patient population was 40.2% women, 55.6% were aged 51-64 years, 32.0% were ≥65 years, 70.7% were White, 45.4% had Medicare, 26.8% had Medicaid, 10.5% had chronic pain, and 77.1% were admitted through the emergency department.

The cohort with cirrhosis were more likely to be non-White, to have chronic pain, and more comorbidities (all P <.001). The etiologies of cirrhosis were nonalcoholic steatohepatitis or other (48.0%), alcohol (39.1%), and hepatitis C (12.9%) and 54.6% had decompensated cirrhosis, 43.2% ascites, 25.9% varices, and 23.1% hepatic encephalopathy.

Analgesic use varied by hospital. Regular opioid use ranged between 34.1% to 90.0% (median, 56.5%) and regular acetaminophen use ranged from 0.4% to 56.7% (median, 34.8%).

Analgesic medication(s) were received by 82.6% of the cirrhosis cohort. More than half (58.4%) of analgesic recipients received medication on >50% of hospital days.

Compared with the controls, cirrhosis associated with 14% less analgesic use (odds ratio [OR], 0.86; P <.01) and 12% less regular inpatient analgesic use (OR, 0.88; P <.01), however, the cirrhosis cohort was 42% more likely to have new analgesic use (OR, 1.42; P <.01).

Stratified by analgesic type, fewer patients with cirrhosis received acetaminophen (26% vs 42%; P <.001), nonsteroidal anti-inflammatory drugs (NSAIDs; 3% vs 7%; P <.001), or acetaminophen plus opioids (53% vs 72%; P <.001) and more received opioids (59% vs 54%; P <.001).

Among the cirrhosis cohort, those with decompensated cirrhosis received more regular opioids (60% vs 55%; P <.01).

Risk for opioid use among inpatients with cirrhosis associated with receiving surgical services (adjusted OR [aOR], 2.85; 95% CI, 2.47-3.28; P <.001), diagnosis of chronic pain (aOR, 2.20; 95% CI, 2.06-2.35; P <.001), hepatitis C cirrhotic etiology (aOR, 1.47; 95% CI, 1.39-1.56; P <.001), hospital admission in the Western US (aOR, 1.31; 95% CI, 1.12-1.54; P =.001), hospital admission in the Southern US (aOR, 1.28; 1.04-1.59; P =.02), Black ethnicity (aOR, 1.17; 95% CI, 1.09-1.26; P <.001), Medicare insurance (aOR, 1.14; 95% CI, 1.06-1.21; P <.001), Medicaid insurance (aOR, 1.13; 95% CI, 1.04-1.23; P =.003), and Charlson Comorbidity Index (aOR, 1.02; 95% CI, 1.02-1.03; P <.001).

This study was limited by not having access to clinical details or dosing information.

The study authors concluded that patients with cirrhosis used different types of analgesic drugs compared with their noncirrhotic counterparts. Patients with cirrhosis, especially those with decompensated disease, were more likely to receive opioids. This evidence, combined with the large variation of analgesic use between hospitals, highlights the need to establish evidence-based guidelines for analgesic use among patients with cirrhosis.

Reference

Rubin JB, Lai JC, Shui AM, Hohmann SF, Auerbach A. Cirrhosis Inpatients Receive More Opioids and Fewer Nonopioid Analgesics Than Patients Without Cirrhosis. J Clin Gastroenterol. Published online October 14, 2021. doi:10.1097/MCG.0000000000001624