Inpatient opioid prescribing patterns and their effect on rehospitalisations: a nested case-control study using data from a Swiss public acute hospital

Abstract

AIMS OF THE STUDY: Opioid prescriptions have increased in Switzerland, even though current guidelines warn of their harms. If opioids for postoperative analgesia are not tapered before hospital discharge, patients are at risk of adverse events such as constipation, drowsiness, dependence, tolerance and withdrawal. The aim of this study was to investigate and quantify the potential association between opioids prescribed at discharge from hospital and rehospitalisation. METHODS: We conducted a nested case-control study using routinely collected electronic health records from a Swiss public acute hospital. Cases were patients aged 65 years or older admitted between November 2014 and December 2018, with documented opioid administration on the day of discharge and rehospitalisation within 18 or 30 days after discharge. Each case was matched to five controls for age, sex, year of hospitalisation and Charlson Comorbidity Index. We calculated odds ratios for 18-day and 30-day rehospitalisation based on exposure to opioids using a conditional logistic regression adjusted for potential confounders. Secondary analyses included stratifications into morphine-equivalent doses of 50 mg were rare. CONCLUSIONS: Patients receiving opioids on the day of discharge were 48% more likely to be readmitted to hospital within 30 days. Clinicians should aim to discontinue opioids started in hospital before discharge if possible. Patients receiving an opioid prescription should be educated and monitored as part of opioid stewardship programmes.