Use of Medications and Resources for Treatment of Nausea, Vomiting, or Constipation in Hospitalized Patients Treated With Analgesics

Suh, Dong‐Churl; Kim, Myoung S.; Chow, Wing; Jang, Eun-Jin

doi:10.1097/ajp.0b013e31820d9b76

Cited by 20 publications

(20 citation statements)

References 41 publications

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“…In a large retrospective database analysis of 434,034 patients, 55% of hospitalized patients required treatment for nausea, vomiting, or constipation after administration of opioids (specifically, opioid agonists such as morphine, hydromorphone, or hydrocodone, or partial agonists such as buprenorphine) or nonopioid analgesics (nonsteroidal antiinflammatory drugs or cyclooxygenase‐2 inhibitors). Use of these treatments was almost 5 times more frequent in patients who had received injectable opioids compared with those who had received oral nonopioid analgesics . Moreover, patients who experienced nausea or vomiting during oral opioid therapy had a significantly longer hospital LOS (mean 6.31 vs 5.12 days in those who did not develop nausea or vomiting, p<0.0001), which in turn increased hospital costs by almost $2000/patient ($7801/patient vs $5831/patient in those without nausea or vomiting) …”

Section: Common Types Of Opioid‐related Adverse Drug Events and Patiementioning

confidence: 99%

Challenges in the Management of Acute Postsurgical Pain

Oderda

2012

Pharmacotherapy

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The majority of patients who undergo surgery will require drug therapy for the management of acute postsurgical pain. Effective control of acute postsurgical pain is essential for the patient not only in the short term but also in the long term to prevent the development of chronic pain, which can occur if early acute pain is prolonged. Currently, opioid analgesics are widely used for the management of acute postsurgical pain. Although opioids provide effective postsurgical pain relief, their use is associated with a number of risks, including the development of opioid-related adverse drug events (ORADEs). This review investigates the prevalence of opioid use in the postsurgical setting, the incidence of ORADEs, and the impact of these ORADEs on patient outcomes, length of stay, and costs after common surgeries. According to a national analysis of ORADE incidence, almost 20% of patients treated with opioids experienced an ORADE, with the most common being gastrointestinal effects, central nervous system effects, pruritus, or urinary retention. Studies show that the risk of developing an ORADE is higher in patients receiving higher doses of opioids and in patients undergoing orthopedic or gynecologic surgery compared with patients undergoing general surgery. Elderly patients and those with comorbidities (e.g., obesity, sleep apnea, respiratory disease, urinary disorders) may be particularly vulnerable to ORADE development. Both hospital costs and length of stay are increased in patients with an ORADE versus those without an ORADE. Strategies to reduce the use of opioids after surgery are likely to result in positive outcomes by reducing the incidence of ORADEs and, as a result, reducing treatment costs associated with surgery and improving patient care.

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Section: Common Types Of Opioid‐related Adverse Drug Events and Patiementioning

confidence: 99%

Challenges in the Management of Acute Postsurgical Pain

Oderda

2012

Pharmacotherapy

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“…Of note, NV accounted for approximately 50% of all opioid-related ADEs in this study. In another study among hospitalized patients who received oral opioids, those who received medication for nausea, vomiting, or constipation were hospitalized 1.36 days longer than those who did not receive any such medication, at an additional cost of $2223 per patient (both P < 0.0001) [41]. Medication for nausea, vomiting, or constipation was also associated with a longer hospital length of stay and greater costs per patient among patients who received injectable (including epidural) opioids in that study [41].…”

Section: Discussionmentioning

confidence: 99%

Health Care Utilization and Costs Associated with Nausea and Vomiting in Patients Receiving Oral Immediate-Release Opioids for Outpatient Acute Pain Management

Marrett

Kwong

Frech³

et al. 2016

Pain Ther

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IntroductionNausea and vomiting (NV) are common side effects of opioid use and limiting factors in pain management. This study sought to quantify the frequency of antiemetic prescribing and the impact of NV on health care resource utilization and costs in outpatients prescribed opioids for acute pain. The perspective was that of a commercial health plan.MethodsMedical and pharmacy claims from IMS PharMetrics Plus were used to identify patients initiating opioid therapy with a prescription for an oxycodone-, hydrocodone- or codeine-containing immediate-release product for acute use (≤15-day supply) between October 1, 2013 and September 30, 2014. Patients with a medical claim for NV (International Classification of Diseases, Ninth Revision, Clinical Modification codes 787.0x), with or without an antiemetic prescription fill, were compared with patients with no NV claim or antiemetic prescription fill to assess differences in all-cause health care utilization and costs over 1 month. Propensity score matching (PSM) was used to adjust for between-group differences in baseline patient characteristics.ResultsThe co-prescribing of opioids with antiemetic agents was 10.2%. After PSM (n = 45,790 per group), patients with NV claims had significantly more hospitalizations (11.5% vs 4.2%), emergency department visits (65.0% vs 12.1%), and physician office visits (85.2% vs 64.5%) compared with patients with no NV claims (all P < 0.0001). Mean total health care costs were higher among patients with a NV claim versus those without evidence of the side effect ($6290 vs $2309; P < 0.0001). Among patients with a recent hospitalization, patients with NV claims had higher rates of 30-day rehospitalization than those with no NV claims (24.4% vs 3.0%; P < 0.0001).ConclusionsAmong outpatients prescribed opioids for management of acute pain, co-prescribing with antiemetics was low, and the economic burden associated with NV was high. Efforts to prevent NV in patients receiving opioid therapy may improve patient outcomes and provide cost savings to the health care system.FundingDaiichi Sankyo, Inc.Electronic supplementary materialThe online version of this article (doi:10.1007/s40122-016-0057-y) contains supplementary material, which is available to authorized users.

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“…Some studies have identified an association between opioid analgesic administration and the development of constipation among hospitalised patients . The lack of association in the Lim study may be driven by differences in the sample of patients studied.…”

mentioning

confidence: 80%

“…Also, both a prior study and this study identify an association between greater length of stay and constipation. One study that showed a strong association between opioid analgesics and constipation did not adjust for length of stay . Since the stroke patients in this study had a markedly longer mean length of stay than the orthopaedic patients, this omission may be driving the disparate conclusions.…”

mentioning

confidence: 89%

“…The decision to match the two cohorts on age and sex is probably also influencing the study findings. For example, age and female gender have been identified as risk factors for constipation among hospitalised patients . Unmatched stroke patients would be older, increasing the risk for constipation relative to a random sample of patients admitted for orthopaedic conditions.…”

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confidence: 99%

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Constipation during acute hospitalisation: vigilance critical for all patients at high risk

Ruhnke

Meltzer

2015

Int J Clin Pract

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Use of Medications and Resources for Treatment of Nausea, Vomiting, or Constipation in Hospitalized Patients Treated With Analgesics

Abstract: Use of an analgesic with improved gastrointestinal tolerability may potentially reduce use of NVC medications and hospital resources.

Cited by 20 publications

References 41 publications

Challenges in the Management of Acute Postsurgical Pain

Challenges in the Management of Acute Postsurgical Pain

Health Care Utilization and Costs Associated with Nausea and Vomiting in Patients Receiving Oral Immediate-Release Opioids for Outpatient Acute Pain Management

Constipation during acute hospitalisation: vigilance critical for all patients at high risk

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