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Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study.
BMJ Open. 2019 05 05; 9(5):e025567.BO

Abstract

OBJECTIVES

To study the association between accidental opioid overdose and neurological, respiratory, cardiac and other serious adverse events and whether risk of these adverse events was elevated during hospital readmissions compared with initial admissions.

DESIGN

Retrospective cohort study.

SETTING

Population-based study using linked administrative data in British Columbia, Canada.

PARTICIPANTS

The primary analysis included 2433 patients with 2554 admissions for accidental opioid overdose between 2006 and 2015, including 121 readmissions within 1 year of initial admission. The secondary analysis included 538 patients discharged following a total of 552 accidental opioid overdose hospitalizations and 11 040 matched controls from a cohort of patients with ≥180 days of prescription opioid use.

OUTCOME MEASURES

The primary outcome was encephalopathy; secondary outcomes were adult respiratory distress syndrome, respiratory failure, pulmonary haemorrhage, aspiration pneumonia, cardiac arrest, ventricular arrhythmia, heart failure, rhabdomyolysis, paraplegia or tetraplegia, acute renal failure, death, a composite outcome of encephalopathy or any secondary outcome and total serious adverse events (all-cause hospitalisation or death). We analysed these outcomes using generalised linear models with a logistic link function.

RESULTS

3% of accidental opioid overdose admissions included encephalopathy and 25% included one or more adverse events (composite outcome). We found no evidence of increased risk of encephalopathy (OR 0.57; 95% CI 0.13 to 2.49) or other outcomes during readmissions versus initial admissions. In the secondary analysis, <5 patients in each cohort experienced encephalopathy. Risk of the composite outcome (OR 2.15; 95% CI 1.48 to 3.12) and all-cause mortality (OR 2.13; 95% CI 1.18 to 3.86) were higher for patients in the year following overdose relative to controls.

CONCLUSIONS

We found no evidence that risk of encephalopathy or other adverse events was higher in readmissions compared with initial admissions for accidental opioid overdose. Risk of serious morbidity and mortality may be elevated in the year following an accidental opioid overdose.

Authors+Show Affiliations

Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada. Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, British Columbia, Canada.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

31061028

Citation

Morrow, Richard L., et al. "Outcomes Associated With Hospital Admissions for Accidental Opioid Overdose in British Columbia: a Retrospective Cohort Study." BMJ Open, vol. 9, no. 5, 2019, pp. e025567.
Morrow RL, Bassett K, Maclure M, et al. Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study. BMJ Open. 2019;9(5):e025567.
Morrow, R. L., Bassett, K., Maclure, M., & Dormuth, C. R. (2019). Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study. BMJ Open, 9(5), e025567. https://doi.org/10.1136/bmjopen-2018-025567
Morrow RL, et al. Outcomes Associated With Hospital Admissions for Accidental Opioid Overdose in British Columbia: a Retrospective Cohort Study. BMJ Open. 2019 05 5;9(5):e025567. PubMed PMID: 31061028.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study. AU - Morrow,Richard L, AU - Bassett,Ken, AU - Maclure,Malcolm, AU - Dormuth,Colin R, Y1 - 2019/05/05/ PY - 2019/5/8/entrez PY - 2019/5/8/pubmed PY - 2020/5/14/medline KW - adverse events KW - cohort study KW - opioids KW - overdose SP - e025567 EP - e025567 JF - BMJ open JO - BMJ Open VL - 9 IS - 5 N2 - OBJECTIVES: To study the association between accidental opioid overdose and neurological, respiratory, cardiac and other serious adverse events and whether risk of these adverse events was elevated during hospital readmissions compared with initial admissions. DESIGN: Retrospective cohort study. SETTING: Population-based study using linked administrative data in British Columbia, Canada. PARTICIPANTS: The primary analysis included 2433 patients with 2554 admissions for accidental opioid overdose between 2006 and 2015, including 121 readmissions within 1 year of initial admission. The secondary analysis included 538 patients discharged following a total of 552 accidental opioid overdose hospitalizations and 11 040 matched controls from a cohort of patients with ≥180 days of prescription opioid use. OUTCOME MEASURES: The primary outcome was encephalopathy; secondary outcomes were adult respiratory distress syndrome, respiratory failure, pulmonary haemorrhage, aspiration pneumonia, cardiac arrest, ventricular arrhythmia, heart failure, rhabdomyolysis, paraplegia or tetraplegia, acute renal failure, death, a composite outcome of encephalopathy or any secondary outcome and total serious adverse events (all-cause hospitalisation or death). We analysed these outcomes using generalised linear models with a logistic link function. RESULTS: 3% of accidental opioid overdose admissions included encephalopathy and 25% included one or more adverse events (composite outcome). We found no evidence of increased risk of encephalopathy (OR 0.57; 95% CI 0.13 to 2.49) or other outcomes during readmissions versus initial admissions. In the secondary analysis, <5 patients in each cohort experienced encephalopathy. Risk of the composite outcome (OR 2.15; 95% CI 1.48 to 3.12) and all-cause mortality (OR 2.13; 95% CI 1.18 to 3.86) were higher for patients in the year following overdose relative to controls. CONCLUSIONS: We found no evidence that risk of encephalopathy or other adverse events was higher in readmissions compared with initial admissions for accidental opioid overdose. Risk of serious morbidity and mortality may be elevated in the year following an accidental opioid overdose. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/31061028/Outcomes_associated_with_hospital_admissions_for_accidental_opioid_overdose_in_British_Columbia:_a_retrospective_cohort_study_ L2 - https://bmjopen.bmj.com/lookup/pmidlookup?view=long&amp;pmid=31061028 DB - PRIME DP - Unbound Medicine ER -