Opoid Use Disorder and Vaso-Occlusive Crisis Outcomes: A Retrospective Assesement

Introduction

Concerns by providers for addiction can lead to under-treatment of pain in patients with sickle cell disease presenting with vaso-occlusive crisis. In patients who experience frequent vaso-occlusive crises, opioid dependence may be due to the need for pain control as opposed to addiction and the clinical meaning of a diagnosis of opioid use disorder and its impact on outcomes in this population is not known.

Methods

We retrospectively assessed hospitalizations in the United States for vaso-occlusive crisis in adult patients afflicted with Sickle cell disease from 2016-2019 using the National Inpatient Sample database. Outcomes were compared between those with and without a diagnosis of opioid use disorder using linear and logistical regression.

Results

In total, there were 273,460 hospitalizations for vaso-occlusive crisis, 23,120 (8.5%) of which involved a secondary diagnosis of opioid use disorder. Black Race was associated with opioid use disorder, but age, sex and income were not. After adjusting for confounders, hospital length of stay was increased in patients with opioid use disorder by 1.23 days (95% CI: 1.02 to 1.45, p<0.001) and total hospital charges were increased by $5,566 (95% CI: 3,863 to 7,269, p<0.001) (Table 1). Mortality was decreased in vaso-occulsive crisis hospitalizations in those with opioid use disorder, but the difference was not significant (OR=0.58, 95% CI: 0.026-1.33, p=0.199).

Conclusion

Opioid use disorder is associated with an increased length of stay and cost in patients with vaso-occlusive crisis. Providers should consider under-treatment of pain as a potential diagnosis when addiction concerns are present and individualized pain plans should be explored.