Table 3.
Association Between Patterns of Opioid Administration and Outpatient Opioid Use at 90 and 365 Days After Discharge Among Inpatients Receiving Opioids*
| Variable | ≤90 Days After Discharge | ≤365 Days After Discharge | ||
|---|---|---|---|---|
| Outpatient Opioid Use (95% CI), % | Difference (95% CI), percentage points | Outpatient Opioid Use (95% CI), % | Difference (95% CI), percentage points | |
| Proportion of stay with opioids administered | ||||
| 1%–25% | 5.4 (4.8 to 5.9) | Reference | 6.6 (6.0 to 7.3) | Reference |
| 26%–50% | 5.6 (5.2 to 5.9) | 0.2 (−0.2 to 0.7) | 7.4 (7.0 to 7.8) | 0.8 (0.2 to 1.5) |
| 51%–75% | 6.5 (6.2 to 6.8) | 1.1 (0.5 to 1.6) | 8.5 (8.1 to 8.8) | 1.9 (1.3 to 2.6) |
| 76%–100% | 6.4 (6.0 to 6.8) | 1.0 (0.4 to 1.5) | 8.4 (7.9 to 8.8) | 1.8 (1.2 to 2.5) |
| Time from last opioid administration to discharge | ||||
| >24 h | 3.9 (3.6 to 4.2) | Reference | 5.4(5.1 to 5.8) | Reference |
| 13–24 h | 5.4 (5.0 to 5.9) | 1.5 (1.1 to 2.0) | 6.9 (6.5 to 7.4) | 1.5 (1.1 to 2.0) |
| 0–12 h | 7.5 (7.2 to 7.8) | 3.6 (3.3 to 3.9) | 9.6 (9.2 to 9.9) | 4.2 (3.8 to 4.6) |
| Setting of first opioid administration | ||||
| Stepdown unit/ward | 6.0 (5.7 to 6.3) | Reference | 7.8 (7.5 to 8.1) | Reference |
| ED | 6.1 (5.6 to 6.5) | 0.1 (−0.4 to 0.5) | 7.9 (7.4 to 8.4) | 0.1 (−0.3 to 0.6) |
| ICU | 6.4 (5.6 to 7.1) | 0.4 (−0.2 to 1.1) | 8.1 (7.2 to 9.0) | 0.3 (−0.6 to 1.2) |
| PACU/procedure unit | 6.0 (5.7 to 6.4) | 0 (−0.3 to 0.4) | 8.0 (7.6 to 8.4) | 0.2 (−0.2 to 0.6) |
| Any inpatient use of nonopioid analgesic | ||||
| None | 6.0 (5.8 to 6.2) | Reference | 7.8 (7.6 to 8.1) | Reference |
| ≥1 time during stay | 6.3 (6.0 to 6.7) | 0.3 (0.1 to 0.7) | 8.2 (7.8 to 8.5) | 0.4 (0.0 to 0.7) |
ED = emergency department; HCUP CCS = Healthcare Cost and Utilization Project Clinical Classifications Software; ICU = intensive care unit; PACU = postanesthesia care unit.
Includes 92 433 stays with inpatient opioid use that met all other inclusion criteria. The table shows predicted margins obtained from 2 multinomial logistic regression models (full results shown in Supplement Tables 4 and 5 [available at Annals.org]) that included indicators of various inpatient opioid use patterns and adjusted for the following covariates: age, sex, race, year of admission, payment source for hospital stay (e.g., Medicare or Medicaid), Elixhauser Comorbidity Index score, admission type (medical with no ICU stay, medical with ICU stay, surgical with no ICU stay, or surgical with ICU stay), length of stay, hospital fixed effects, HCUP CCS comorbid conditions, and history of benzodiazepine use. Outpatient opioid use at 90 and 365 d after discharge was the key outcome of interest, and death and readmission (both measured ≤90 d after discharge) were treated as competing risks and thus as separate levels of the outcome. Robust SEs were used to account for within-patient correlation.