Umar Hayat, MBBS1, Maham Waqar, MBBS2, Fnu Faheela, MBBS3, Muhammad Kamal, MD4, Osama Abu-Shawer, MD, MS5, Ali Raza, MBBS, FCPS3, Muhammad Haseeb, MD, MSc6 1University of Kansas, Wichita, KS; 2King Edward Medical University, Lahore, Punjab, Pakistan; 3Nishtar Medical University, Multan, Punjab, Pakistan; 4Essen Healthcare System, New York, NY; 5Cleveland Clinic, Cleveland, OH; 6Beth Israel Deaconess Medical Center, Boston, MA
Introduction: Opioids are widely used for pain management in Inflammatory Bowel Disease (IBD). Thus, IBD patients are more prone to developing Opioid Use Disorder (OUD). Therefore, our study aimed to evaluate the impact of OUD on resource utilization in patients hospitalized with IBD in the US.
Methods: National Inpatient Sample (NIS) for 2019 was queried using ICD-10-CM Codes to identify a cohort of inpatient IBD admissions with and without OUD. A weighted sample was used to get baseline characteristics and resource utilization (length of stay and total hospital charges) during the inpatient admissions. Then, multivariate linear regression analysis followed by predictive margins of the model was used to get adjusted estimates of the length of stay and total hospital charges.
Results: Among 92740 patients admitted with IBD, 2335 (2.5%) had a concurrent diagnosis of OUD. Patients with OUD were comparatively younger (42.9 vs. 46.7) and predominantly Caucasians (79.1%). Our cohort was broadly admitted to large urban teaching hospitals. Compared to patients with OUD, there were larger proportions of patients with private insurance without OUD (24.6% vs. 48.5%). OUD was associated with a significantly longer length of stay in IBD patients, 6.10 days (95% CI 5.31-6.88) vs. 4.92 days (95% CI 4.83-5.02) for patients without OUD in the adjusted model. Total hospital charges were also higher, 77013 (95% CI 50604-103421) with OUD vs. 51399 (95% CI 49133-53665) for patients without OUD. In addition, 6% of patients with OUD were discharged against medical advice compared to 2.2 % of patients without OUD.
Discussion: Our study shows that OUD was associated with increased resource utilization in patients admitted with IBD. They had a longer length of stay despite an increased number of these patients leaving against medical advice. It resulted in increased hospital charges. Careful attention is needed to monitor disease status and pain severity in both inpatient and outpatient settings to decrease hospitalization and resource utilization. Future studies are needed with better cohort stratification to assess mitigating factors to OUD in patients with IBD.
Figure: IBD= Inflammatory Bowel Disease ; IBD+OUD= Inflammatory Bowel Disease with Opioid Use Disorder
Variables
IBD without OUD
(90405)
IBD with OUD
(2335)
p-value
a) Baseline Patient and Hospital Characteristics
Age (SD)
46.7 (18.4)
42.9 (13.2)
< 0.01
Female (%)
49030 (54.2)
1150 (49.3)
0.04
Race (%)
0.07
White
65285 (73.7)
1820 (79.1)
Charlson Comorbidity Index (SD)
0.72 (1.3)
0.79 (1.3)
0.20
Hospital Type (%)
Urban
84395 (93.4)
2200 (94.2)
0.49
Teaching
70020 (77.5)
1835 (78.6)
0.59
Hospital Bed Size (Large)
46905 (51.9)
1290 (55.3)
0.06
Payer Information (%)
< 0.01
Medicare
24175 (27.8)
840 (36.6)
Private Insurance
42180 (48.5)
565 (24.6)
Disposition (%)
< 0.01
Home
AMA
Died
74325 (82.2)
1985 (2.2)
260 (0.3)
1820 (77.9)
140 (6.0)
10 (0.4)
b) Resource Utilization
LOS (Unadjusted)
4.91 (95% CI 4.81-5.02)
6.17 (95% CI 5.39-6.94)
< 0.01
LOS (Adjusted)
4.92 (95% CI 4.83-5.02)
6.10 (95% CI 5.31-6.88)
< 0.01
TOTAL CHARGES (Unadjusted)
51184 (95% CI 48817-53551)
77603 (95% CI 51333-103874)
0.05
TOTAL CHARGES (Adjusted)
51399 (95% CI 49133-53665)
77013 (95% CI 50604-103421)
0.05
Table: Adjusted for Age, Charlson Comorbidity Index, Hospital (Location, Teaching status, Bed Size), Insurance status.
IBD: Inflammatory Bowel Disease ; OUD: Opioid Use Disorder ; SD: Standard Deviation ; AMA: Against Medical Advice ; LOS: Length Of Stay
Disclosures:
Umar Hayat indicated no relevant financial relationships.
Maham Waqar indicated no relevant financial relationships.
Fnu Faheela indicated no relevant financial relationships.
Muhammad Kamal indicated no relevant financial relationships.
Osama Abu-Shawer indicated no relevant financial relationships.
Ali Raza indicated no relevant financial relationships.
Muhammad Haseeb indicated no relevant financial relationships.
Umar Hayat, MBBS1, Maham Waqar, MBBS2, Fnu Faheela, MBBS3, Muhammad Kamal, MD4, Osama Abu-Shawer, MD, MS5, Ali Raza, MBBS, FCPS3, Muhammad Haseeb, MD, MSc6. A0343 - Impact of Opioid Use Disorder on Resource Utilization in Patients Admitted With Inflammatory Bowel Disease: A Nationwide Analysis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.
