Presentation Details
| Opioid Escalation in the ICU and 90-Day Readmission After Major Surgery: A Retrospective Cohort Study Using the MIMIC-IV Database Angel Agyemang Prempeh, Allison Tenfelde. Michigan State University College of Human Medicine, East Lansing, MI, USA |
Abstract
BACKGROUND: Opioid stewardship is a central concern in postoperative critical care. In non-ICU settings, opioid escalation is linked to poor pain control and complications. We examined whether short-term opioid escalation within the first 72 hours after major surgery predicts 90-day readmission among intensive care unit (ICU) patients.
METHODS: This retrospective cohort study used the publicly available Medical Information Mart for Intensive Care IV (MIMIC-IV, version 3.1) database (2008–2022). Adults aged ≥ 18 years admitted to the ICU after major orthopedic, general, or neurosurgical procedures were included. Opioid escalation was defined as total morphine milligram equivalents (MME) administered during hours 48–71 exceeding twice the MME during hours 0–23 after ICU admission. The primary outcome was all-cause hospital readmission within 90 days of discharge. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), controlling for age, sex, Charlson Comorbidity Index (CCI), and surgical category.
RESULTS: Of 613 patients analyzed, mean (SD) age was 65 (15) years and 342 (55.8%) were male. Opioid escalation occurred in 126 patients (20.6%), and readmission in 229 (37.4%). In multivariable logistic regression adjusted for age, sex, Charlson Comorbidity Index, and surgical category, escalation was not associated with readmission (adjusted odds ratio, 1.05; 95% CI, 0.68 to 1.63; P = .83).
CONCLUSIONS: In critically ill postoperative patients, short-term opioid escalation was not associated with 90-day readmission. These null findings suggest escalation may be a poor-quality metric in the intensive care unit due to high baseline opioid exposure and continuous monitoring; further evaluation in non-intensive care unit settings is warranted.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
METHODS: This retrospective cohort study used the publicly available Medical Information Mart for Intensive Care IV (MIMIC-IV, version 3.1) database (2008–2022). Adults aged ≥ 18 years admitted to the ICU after major orthopedic, general, or neurosurgical procedures were included. Opioid escalation was defined as total morphine milligram equivalents (MME) administered during hours 48–71 exceeding twice the MME during hours 0–23 after ICU admission. The primary outcome was all-cause hospital readmission within 90 days of discharge. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), controlling for age, sex, Charlson Comorbidity Index (CCI), and surgical category.
RESULTS: Of 613 patients analyzed, mean (SD) age was 65 (15) years and 342 (55.8%) were male. Opioid escalation occurred in 126 patients (20.6%), and readmission in 229 (37.4%). In multivariable logistic regression adjusted for age, sex, Charlson Comorbidity Index, and surgical category, escalation was not associated with readmission (adjusted odds ratio, 1.05; 95% CI, 0.68 to 1.63; P = .83).
CONCLUSIONS: In critically ill postoperative patients, short-term opioid escalation was not associated with 90-day readmission. These null findings suggest escalation may be a poor-quality metric in the intensive care unit due to high baseline opioid exposure and continuous monitoring; further evaluation in non-intensive care unit settings is warranted.
No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author.
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