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Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study

OBJECTIVES: To study the association between accidental opioid overdose and neurological, respiratory, cardiac and other serious adverse events and whether risk of these adverse events was elevated during hospital readmissions compared with initial admissions. DESIGN: Retrospective cohort study. SET...

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Autores principales: Morrow, Richard L, Bassett, Ken, Maclure, Malcolm, Dormuth, Colin R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502019/
https://www.ncbi.nlm.nih.gov/pubmed/31061028
http://dx.doi.org/10.1136/bmjopen-2018-025567
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author Morrow, Richard L
Bassett, Ken
Maclure, Malcolm
Dormuth, Colin R
author_facet Morrow, Richard L
Bassett, Ken
Maclure, Malcolm
Dormuth, Colin R
author_sort Morrow, Richard L
collection PubMed
description OBJECTIVES: To study the association between accidental opioid overdose and neurological, respiratory, cardiac and other serious adverse events and whether risk of these adverse events was elevated during hospital readmissions compared with initial admissions. DESIGN: Retrospective cohort study. SETTING: Population-based study using linked administrative data in British Columbia, Canada. PARTICIPANTS: The primary analysis included 2433 patients with 2554 admissions for accidental opioid overdose between 2006 and 2015, including 121 readmissions within 1 year of initial admission. The secondary analysis included 538 patients discharged following a total of 552 accidental opioid overdose hospitalizations and 11 040 matched controls from a cohort of patients with ≥180 days of prescription opioid use. OUTCOME MEASURES: The primary outcome was encephalopathy; secondary outcomes were adult respiratory distress syndrome, respiratory failure, pulmonary haemorrhage, aspiration pneumonia, cardiac arrest, ventricular arrhythmia, heart failure, rhabdomyolysis, paraplegia or tetraplegia, acute renal failure, death, a composite outcome of encephalopathy or any secondary outcome and total serious adverse events (all-cause hospitalisation or death). We analysed these outcomes using generalised linear models with a logistic link function. RESULTS: 3% of accidental opioid overdose admissions included encephalopathy and 25% included one or more adverse events (composite outcome). We found no evidence of increased risk of encephalopathy (OR 0.57; 95% CI 0.13 to 2.49) or other outcomes during readmissions versus initial admissions. In the secondary analysis, <5 patients in each cohort experienced encephalopathy. Risk of the composite outcome (OR 2.15; 95% CI 1.48 to 3.12) and all-cause mortality (OR 2.13; 95% CI 1.18 to 3.86) were higher for patients in the year following overdose relative to controls. CONCLUSIONS: We found no evidence that risk of encephalopathy or other adverse events was higher in readmissions compared with initial admissions for accidental opioid overdose. Risk of serious morbidity and mortality may be elevated in the year following an accidental opioid overdose.
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spelling pubmed-65020192019-05-21 Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study Morrow, Richard L Bassett, Ken Maclure, Malcolm Dormuth, Colin R BMJ Open Epidemiology OBJECTIVES: To study the association between accidental opioid overdose and neurological, respiratory, cardiac and other serious adverse events and whether risk of these adverse events was elevated during hospital readmissions compared with initial admissions. DESIGN: Retrospective cohort study. SETTING: Population-based study using linked administrative data in British Columbia, Canada. PARTICIPANTS: The primary analysis included 2433 patients with 2554 admissions for accidental opioid overdose between 2006 and 2015, including 121 readmissions within 1 year of initial admission. The secondary analysis included 538 patients discharged following a total of 552 accidental opioid overdose hospitalizations and 11 040 matched controls from a cohort of patients with ≥180 days of prescription opioid use. OUTCOME MEASURES: The primary outcome was encephalopathy; secondary outcomes were adult respiratory distress syndrome, respiratory failure, pulmonary haemorrhage, aspiration pneumonia, cardiac arrest, ventricular arrhythmia, heart failure, rhabdomyolysis, paraplegia or tetraplegia, acute renal failure, death, a composite outcome of encephalopathy or any secondary outcome and total serious adverse events (all-cause hospitalisation or death). We analysed these outcomes using generalised linear models with a logistic link function. RESULTS: 3% of accidental opioid overdose admissions included encephalopathy and 25% included one or more adverse events (composite outcome). We found no evidence of increased risk of encephalopathy (OR 0.57; 95% CI 0.13 to 2.49) or other outcomes during readmissions versus initial admissions. In the secondary analysis, <5 patients in each cohort experienced encephalopathy. Risk of the composite outcome (OR 2.15; 95% CI 1.48 to 3.12) and all-cause mortality (OR 2.13; 95% CI 1.18 to 3.86) were higher for patients in the year following overdose relative to controls. CONCLUSIONS: We found no evidence that risk of encephalopathy or other adverse events was higher in readmissions compared with initial admissions for accidental opioid overdose. Risk of serious morbidity and mortality may be elevated in the year following an accidental opioid overdose. BMJ Publishing Group 2019-05-05 /pmc/articles/PMC6502019/ /pubmed/31061028 http://dx.doi.org/10.1136/bmjopen-2018-025567 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
spellingShingle Epidemiology
Morrow, Richard L
Bassett, Ken
Maclure, Malcolm
Dormuth, Colin R
Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study
title Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study
title_full Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study
title_fullStr Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study
title_full_unstemmed Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study
title_short Outcomes associated with hospital admissions for accidental opioid overdose in British Columbia: a retrospective cohort study
title_sort outcomes associated with hospital admissions for accidental opioid overdose in british columbia: a retrospective cohort study
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6502019/
https://www.ncbi.nlm.nih.gov/pubmed/31061028
http://dx.doi.org/10.1136/bmjopen-2018-025567
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