Methods: This one year retrospective cohort study of hospitalized medical patients, aged 65 and older, in a large academic tertiary care facility in the New York metropolitan area, compared subjects who received opiates to those that did not. Data collected included opiate use prior to admission, concurrent use of Potentially Inappropriate Medications (PIMs), adverse events, discharge disposition, length of stay (LOS), and 30-day readmissions.
Results: Of the 10,529 subjects, 12.5% reported opiate use prior to hospitalization. During hospitalization, a third of patients (29.3%) received opiates, and 83.9% were newly initiated. Only 11.2% were prescribed opiates at time of discharge. There was no significant difference between those who received and those who did not receive opiates with regards to age, race, gender, ethnicity, and Charlson Comorbidity Index. However, patients who were married were less likely to receive opiates (47.4 vs. 50.1, p<0.0001), and so were patients with dementia (10.06 vs. 19.38, p<0.0001). Patients who received opiates were more likely to be restrained (4.67 vs. 1.81, p<0.0001), to be NPO (47.78 vs. 30.98, p<0.0001), to have indwelling bladder catheters (25.80 vs. 12.69, p<0.0001), and to have bed rest orders (30.70 vs. 21.44, p<0.0001). They were also more likely to receive benzodiazepines and diphenhydramine (19.77 vs. 10.92 and 8.65 vs. 3.41, p <0.0001, respectively). Patients on opiates had a longer LOS (6 vs. 4 days, p<0.0001), were more often discharged to SNF versus home (14.1 vs. 7.85 and 87.51 vs.75.59, p<0.0001), and more often readmitted within 30 days (21.88 vs. 19.53, p=0.0063).
Conclusions:
While patterns of opiate prescribing in the hospital did not seem affected by recent CMS regulations, practitioners appeared more cautious at time of discharge. In addition, the use of opiates during hospitalization was associated with multiple negative outcomes, of particular concern for the geriatric population.