Analysis of the Impact of Preadmission, Inpatient, and Discharge Opioid Exposure and Dose on 30- and 90-Day Hospital Readmissions in Patients with Inflammatory Bowel Disease Exacerbations.

Background: Opioid use is common among patients hospitalized for inflammatory bowel disease (IBD) exacerbation and has been associated with an increased risk of readmissions. Prior studies, however, have mostly limited their analysis to hospital opioid use. This study examines opioid exposure and dosing before, during, and after hospitalization and its impact on 30- and 90-day hospital readmissions. Methods: We reviewed all adults admitted for an IBD exacerbation from 1 January 2016 to 3 January 2020, excluding pregnant patients and those with an IBD-related surgery. Use and dose of opioids before and during hospitalization and at discharge were identified through manual chart review. IBD type, demographics, and comorbidities were defined. The associations between opioid use characteristics and readmission were assessed using a series of multivariable logistic regression models. Results: Among 1062 patients meeting inclusion criteria, 191 (18.0%) were readmitted within 30 days of their index hospitalization, and 285 (26.8%) were readmitted within 90 days. Of these 1062 patients, 96 (9.02%) had preadmission opioid use, 340 (31.95%) had inpatient use, and 133 (12.50%) received a discharge opioid prescription. Preadmission, inpatient, and discharge opioid use were not associated with 30-day readmission. Preadmission and inpatient opioid use were also not associated with 90-day readmission; however, a prescription for an opioid at discharge was associated with 90-day readmission even after adjusting for confounders, OR 1.86 (1.27, 2.75), p = 0.002. On multivariable analysis, we also found that higher maximum daily dose of discharge opioids, OR 1.01 (1.00, 1.02), p = 0.037, was found to be associated with 30-day readmissions, and higher opioid doses preadmission, OR 1.01 (1.00, 1.03), p = 0.029, and at hospital discharge, OR 1.01 (1.00, 1.02), p = 0.034, were associated with increased 90-day readmission. Conclusions: Opioid prescribing at discharge poses a significant risk for readmissions. Discharge planning should emphasize minimal use of opioids at discharge.