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Sunday, December 2, 2018

Opioid Use Not Tied to Increase of In-Hospital Sickle Cell Mortality


The use of opioids was not associated with in-hospital mortality among U.S. patients with sickle cell disease (SCD), researchers said here.
Based on an evaluation of data from the National Inpatient Sample (1998-2013, hospitalizations for patients with SCD were identified and hospitalization and in-hospital mortality rates for the entire cohort of patients, as well as different age groups (0-17 years, 18 — 44, 45-64, and ≥65), were identified, explained Oladimeji Akinola Akinboro, MBBS, of Boston University School of Medicine and Boston Medical Center, and colleagues.
They also looked at in-hospital mortality hospitalization rates by U.S. Census Bureau regions, the authors reported at the American Society of Hematology annual meeting.
Akinboro’s group identified 1,775,2220 hospitalizations among SCD patients from 1998 to 2013. While hospitalization rates declined by an average of 9.9% annually from 1998 to 2002 — 39/100,000 persons in 1998 to 27/100,000 persons in 2002 — no significant temporal trends were seen between 2002 and 2013.
The researchers said the findings suggested that despite the ongoing opioid epidemic in the U.S., the number of opioid-related deaths among SCD patients was low, and that the use of opioids for pain control in SCD is safe.
However, the did find a significant increase in hospitalizations in patients ages 18-44 over that time, from 43/100,000 in 2002 to 71/100,000 in 2013. The elderly age group (≥65) also saw the number of hospitalizations increase by 6.5% annually, resulting in the number of hospitalizations doubling in that age group (2.7/100,000 in 1998 to 5.4/100,000 in 2013).
Akinboro pointed out the driver behind the majority of hospitalizations in patients with SCD is a vaso-occlusive crisis marketed by intermittent, unexpected episodes of excruciating pain.
Considering that opioids are the mainstay of chronic pain control in SCD, and that the country has seen a marked increase in opioid-related overdoses and deaths this century, the authors examined hospitalization trends and in-hospital mortality rates among SCD patients, and compared them with rates of opioid prescription-related deaths among the non-SCD population since the beginning of the opioid epidemic.
“Hospitals and physicians have generally been careful with opioid prescriptions, whether it’s with patients with sickle cell disease, or the general population,” Akinboro told MedPage Today. “In carrying out the study, one of our concerns was that sickle cell disease might become undertreated.”
As the for the increase in hospitalization rates in the 18-44 and ages ≥65 groups, Akinboro suggested one reason could be the lack of coordinated care among those age groups, particularly when compared with pediatric SCD patients. Another possible explanation could be that patients with SCD are now living longer and may be developing comorbidities that account for more hospitalizations, he added.
The only geographical region that saw a significant increase in SCD hospitalizations was the South, with an annual increase of 3.5% between 2001 and 2011.
Significantly, the in-hospital SCD mortality rate remained steady through 2013, while the number of non-SCD opioid prescription-related deaths increased by 350% over the same time.
“While we didn’t look directly at opioid prescription patterns for sickle cell disease, what our study uniquely shows is that, using this large nationwide database, that deaths in a hospital setting related to opioid toxicity or overdose almost never happen among those with sickle cell disease,” said Akinboro. “This suggests that current patterns of opioid use in this population is safe, assuming we continue the same risk-mitigation strategies.”
John J. Strouse, MD, PhD, of Duke University Medical School in Durham, N.C., said that a potential concern is that deaths from opioid overdose often occur outside of the hospital, “and therefore would not increase hospital mortality.” Strouse was not involved in the study.
In a 2016 article in Pain Medicine, researchers looked at data (1999-2013) from the CDC Multiple Cause of Death Database, and determined that in 2008, 14,795 individuals (not including SCD patients) died due to opioid pain relief overdose, compared to just five patients with SCD.
That same trend was seen every year between 1999 and 2013, with 10 being the highest number of deaths due to SCD and opioid overdose.
“The current national opioid phobia may, unwittingly, deny opioids to patients who really need them, especially those patients who experience recurrent episodes of acute pain such as patients with SCD,” the authors of the 2016 article noted.
Akinboro and co-authors disclosed no relevant relationships with industry.

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