Resumen de Opiate Prescribing in Hospitalized Older Adults: Patterns and Outcomes

Sutapa Maiti, Liron Sinvani, Michele Pisano, Andrzej Kozikowski, Vidhi Patel, Meredith Akerman, Karishma Patel, Christopher Smilios, Christian Nouryan, Guang Qiu-, Renee Pekmezaris, Gisele Wolf-Klein

• Objectives Whereas opiate prescribing patterns have been well described in outpatient and emergency department settings, they have been less defined in hospitalized older adults. The objective was to describe patterns of opiate prescribing and associated outcomes in hospitalized older adults.

  Design Retrospective cohort study.

  Setting Tertiary care facility.

  Participants Hospitalized medical patients aged 65 and older (N = 9,245; mean age 80.3, 55.2% female, 72.3% white, 90.8% non‐Hispanic).

  Measurements Opiate exposure and duration of action, concurrent use of potentially inappropriate medications (PIMs), adverse events, discharge disposition, length of stay (LOS), and 30‐day readmissions.

  Results There was no difference in sex, race, ethnicity, or Charlson Comorbidity Index between opiate exposure groups. Participants who had never received opiates had a significantly shorter mean LOS than prior and new opiate users (5.2, 6.8, 7.7 days; P < .001) and were more likely to be discharged home (88.6%, 82.8%, 82.5%; P < .001) and significantly less likely to be readmitted within 30‐days (19.6%, 25.0%, 22.3%; P < .001). Participant who had never been exposed to opiates had a significantly shorter mean LOS than those receiving short‐ and long‐acting opiates (5.2, 7.3, 8.6 days; P < .001) and were more likely to be discharged home (88.6%, 82.6%, 82.4%; P < .001) and significantly less likely to be readmitted within 30‐days (19.6%, 27.7%, 28.9%; P < .001).

  Conclusion Opiate use is widespread during hospitalization and is associated with significant negative clinical outcomes and quality metrics. There is an urgent need to develop innovative pain management alternatives to opiate use.