Predictors for 30-Day and 90-Day Hospital Readmission Among Patients With Opioid Use Disorder

Abstract

Objectives: To identify the incidence, characteristics, and predictors for 30 and 90-day readmission among acutely hospitalized patients with opioid use disorder (OUD). Methods: This retrospective, cohort study evaluated consecutive adults with OUD admitted to an academic medical center over a 5-year period (10/1/11 to 9/30/16). Multivariable logistic regression was used to determine independent predictors for 30 and 90-day readmissions based on pertinent admission, hospital, and discharge variables collected via chart review and found to be different (with a P < 0.10) on univariate analysis. Results: Among the 470 adults (mean age 43.1 AE 12.8 years, past heroin use 77.9%; admission opioid agonist therapy use [buprenorphine 22.6%; methadone 27.0%]; medical [vs surgical] admission 75.3%, floor [vs ICU] admission 93.0%, in-hospital mortality 0.9%), 85 (18.2%) and 151 (32.1%) were readmitted within 30 and 90 days, respectively. Among the 90-day readmitted patients, median time to first readmission was 26 days. Buprenorphine use (vs no use) at index hospital admission was independently associated with reduced 30day (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.24-0.93) and 90-day (OR 0.57, 95% CI 0.34-0.96) readmission; prior heroin (vs prescription opioid) use was associated with reduced 90-day readmission (OR 0.59, 95% CI 0.37-0.94) and length of hospital stay was associated with both greater 30-day (OR 1.02, 95% CI 1.01-1.05) and 90-day (OR 1.04, 95% CI 1.01-1.06) readmission rates. Conclusions: Among patients with OUD taking buprenorphine at the time of hospital admission, 30-day and 90-day hospital readmission was reduced by 53% and 43%, respectively.

Subtypes in patients with opioid misuse: A prognostic enrichment strategy using electronic health record data in hospitalized patients

“…One quarter of patients in this subtype had been diagnosed with a mental health condition in our health system, and this subtype had the highest proportion of patients leaving against medical advice. Buprenorphine initiation during the hospital encounter has been shown to reduce hospitalizations in a similar cohort of patients with heroin use [44]. The high rates of uninsured status, low SES metrics from the census-tract variables (% in poverty, unemployed, education, and median household earnings), and high rates of mental health conditions imply behavioral and social determinants of health are important considerations in this subtype [45].…”

Opioid Agonist Therapy During Hospitalization Within the Veterans Health Administration: a Pragmatic Retrospective Cohort Analysis

“…3,5 Opioid agonist therapy (OAT)-buprenorphine or methadone 6 -are provided infrequently and variably during hospitalization 7 or upon discharge. 8 Underutilization occurs although OAT delivery during hospitalization is feasible 9,10 and OAT receipt is associated with decreased illicit opioid use upon discharge, 9 reduced 30 and 90-day readmissions, 11 and increased post-hospital substance use disorder (SUD) treatment engagement. 11,12 Veterans are particularly vulnerable as they are twice as likely to die from accidental opioid overdose than non-veterans.…”

“…8 Underutilization occurs although OAT delivery during hospitalization is feasible 9,10 and OAT receipt is associated with decreased illicit opioid use upon discharge, 9 reduced 30 and 90-day readmissions, 11 and increased post-hospital substance use disorder (SUD) treatment engagement. 11,12 Veterans are particularly vulnerable as they are twice as likely to die from accidental opioid overdose than non-veterans. 13 OUD diagnoses within the Veterans Health Administration (VHA) have increased by nearly two-fold between 2004 (n = 30,093) 14 and 2017 (n = 54,078).…”

Agreement between self-reported psychoactive substance use and urine toxicology results for adults with opioid use disorder admitted to hospital

“…We undertook an IRB-approved, retrospective, secondary analysis of a cohort of patients admitted for OUD [11]. We used the Partners Research Patient Data Registry (RPDR) to electronically identify consecutive adults admitted to one academic medical center in Boston, MA between October 1, 2011 and September 30, 2016 with either an ICD-9-CM or ICD-10 diagnostic code or problem list item suggestive of OUD (e.g.…”