Skip to main content

Trends in opioid use before critical illness among elderly patients in Ontario

Wang HT, Hill AD, Gomes T, Ruxandra P, Wijeysundera DN, Scales DC, Fowler RA, Wunsch H. J Crit Care. 2020; 55:128-33. Epub 2019 Oct 23. DOI: https://doi.org/10.1016/j.jcrc.2019.10.004


Purpose — To assess temporal trends in pre-existing opioid exposure prior to hospitalization among elderly intensive care unit (ICU) patients and its association with adverse outcomes.

Materials and Methods — We performed a population-based retrospective cohort study using health administrative database from the province of Ontario, Canada. We included all older adult (> 65 years) admissions to an ICU between April 2002 and March 2015. Our exposure was opioid use before admission categorized as chronic use, intermittent use, and non-use.

Results — The cohort included 711,312 elderly patient admissions to an ICU. Of these, 6.8% (n = 48,363) were chronic opioid users, 28.1% (n = 200,149) intermittent users, and 65.0% (n = 462,800) non-users. Compared with non-users, chronic opioid users and intermittent users had higher in-hospital mortality (adjusted odds ratio: 1.12, 95% CI, 1.09–1.15, p < 0.0001 for chronic users; adjusted odds ratio: 1.09, 95% CI, 1.07–1.11, p < 0.0001 for intermittent users), and a lower subdistribution hazard of time to hospital discharge, translating to a longer hospital length of stay (adjusted hazard ratio: 0.87, 95% CI, 0.85–0.88, p < 0.0001 for chronic users; adjusted hazard ratio: 0.93, 95% CI, 0.92–0.94, p < 0.0001 for intermittent users).

Conclusions — Among elderly ICU patients, opioid exposure prior to admission is prevalent and use is associated with higher in-hospital mortality.

×