Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Critical Care, Pharmacy, Internal Medicine, Pediatrics
Analgesics, Opioid, Patient Discharge, Practice Patterns, Physicians, Body Fluids, Intensive Care Units, Humans, Opioid-Related Disorders, Drug Prescriptions
Guidelines for ICU analgesia recommend intravenous opioids as first- line agents, but little information is available regarding ICU opioid administration patterns and association with discharge opioid prescriptions and use. The objective of this study was to describe opioid prescribing patterns in the ICU, the post-ICU hospital stay, and at hospital discharge. This single-center, retrospective study reviewed charts of adult patients admitted to the medical, surgical, or neurological ICU for >24 hours who were discharged alive to a non-hospice environment between October 2014 ? May 2019. Opioid doses were converted to fentanyl equivalents (FE). Patients were classified as receiving an opioid prescription (OP) or not at hospital discharge, and data analyzed using univariate analysis and logistic regression models. Data are reported as mean (SD) or median (IQR); p<0.05 was considered significant. 4,603 ICU patient admissions were included; age was 58.3 (17) years, 57% were male, 55% were mechanically ventilated for 2 (1-6) days, and ICU length of stay was 3.7 (2.1-7.3) days. Patients received 5,156 (12,995) FE in the ICU, averaging 1,140 (2,123) FE per day. Opioid prescriptions prior to admission were identified for 1,481 (32%) patients, who trended to receive higher daily FE doses in the ICU (774 vs 682 mcg/day, p=0.076), and were more likely to receive a discharge OP (65% vs 38%; p<0.001) compared to no opioids prior to admission. Logistic regression demonstrated prior home opioids (OR 3.12, 2.57-3.80, p<0.001), surgical procedures (OR 2.59, 95% CI 2.15-3.11; p<0.001), ICU opioid exposure duration (OR 1.42, 95% CI 1.35-1.51; p<0.001), and total ICU FE dose (OR 1.00, 95% CI 1.00-1.00; p=0.031) were independently associated with discharge OP. Older age (OR 0.99, 95% CI 0.99-1.00; p=0.008) and longer ICU stay (OR 0.76, 95% CI 0.73-0.79, p<0.001) reduced the odds for discharge OP. 32% of ICU patients were prescribed opioids prior to admission, the strongest association with receiving a discharge OP. Surgical procedures, ICU opioid exposure duration, and total ICU FE dose may increase the odds of receiving a discharge OP. Future studies should validate these findings and examine the long-term consequences of ICU opioid administration and discharge opiate prescriptions.
Wampole, Chelsea; Gagnon, David; McKenna, Ariel; Riker, Richard; May, Teresa; Seder, David; Abram, Dawn; and Fraser, Gilles, "Opioid Administration During ICU and Post-ICU Care and Discharge Opioid Prescribing Practices" (2020). Costas T. Lambrew Research Retreat 2020. 69.