New opioid use after invasive mechanical ventilation and hospital discharge
Wunsch H, Hill AD, Fu L, Fowler RA, Wang HT, Gomes T, Fan E, Juurlink DN, Pinto R, Wijeysundera DN, Scales DC. Am J Respir Crit Care Med. 2020; 202(4):568-75. Epub 2020 Apr 29. DOI: https://doi.org/10.1164/rccm.201912-2503OC
Rationale — Patients who receive invasive mechanical ventilation (IMV) are usually exposed to opioids as part of their sedation regimen. The rates of post-hospital prescribing of opioids are unknown.
Objectives — Determine the frequency of persistent post-hospital opioid use among patients who received IMV.
Methods — We assessed opioid-naïve adults who were admitted to an intensive care unit (ICU), received IMV and survived at least 7d after hospital discharge in Ontario, Canada over a 26 month period; February, 2013 through March, 2015. The primary outcome was new persistent opioid use during the year following discharge. We assessed factors associated with persistent use using multivariable logistic regression. Patients receiving IMV were also compared with matched hospitalized patients who did not receive intensive care (non-ICU).
Measurements and Main Results — Among 25,085 opioid-naive IMV patients, 5,007 (20.0%,95%CI 19.5-20.5) filled a prescription for opioids in the 7d following hospital discharge. During the year following, 648 (2.6%,95%CI 2.4-2.8) of the IMV cohort met criteria for new persistent opioid use. The patient characteristic most strongly associated with persistent use in the IMV cohort was being a surgical (vs medical) patient: aOR 3.29,95%CI 2.72-3.97. The rate of persistent use was slightly higher than for matched non-ICU patients ((2.6% vs 1.5%) aOR 1.37,95%CI 1.19-1.58).
Conclusions — Twenty percentage of IMV patients received a prescription for opioids after hospital discharge; 2.6% met criteria for persistent use, an average of 300 new persistent users per year in a population of 14 million. Receipt of surgery was the factor most strongly associated with persistent use.