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. 2019; Oct 23 [Epub ahead of print]. 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.