Inflamm Bowel Dis. 2022 Mar 1;izac021. doi: 10.1093/ibd/izac021. Online ahead of print.

Jessica L Sheehan ¹, Janson Jacob ¹, Elliot M Berinstein ², LaVana Greene-Higgs ¹, Calen A Steiner ³, Sameer K Berry ⁴, Carol Shannon ⁵, Shirley A Cohen-Mekelburg ^4 6 7, Peter D R Higgins ⁴, Jeffrey A Berinstein ^4 7

Author information

1. Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.

2. Department of Medicine, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, USA.

3. Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Colorado, Aurora, Colorado, USA.

4. Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, USA.

5. Taubman Health Sciences Library, University of Michigan, Ann Arbor, Michigan, USA.

6. VA Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI, USA.

7. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.

Abstract

Background: Pain is commonly experienced by patients with inflammatory bowel disease (IBD). Unfortunately, pain management is a challenge in IBD care, as currently available analgesics are associated with adverse events. Our understanding of the impact of opioid use on healthcare utilization among IBD patients remains limited.

Methods: A systematic search was completed using PubMed, Embase, the Cochrane Library, and Scopus through May of 2020. The exposure of interest was any opioid medication prescribed by a healthcare provider. Outcomes included readmissions rate, hospitalization, hospital length of stay, healthcare costs, emergency department visits, outpatient visits, IBD-related surgeries, and IBD-related medication utilization. Meta-analysis was conducted on study outcomes reported in at least 4 studies using random-effects models to estimate pooled relative risk (RR) and 95% confidence interval (CI).

Results: We identified 1969 articles, of which 30 met inclusion criteria. Meta-analysis showed an association between opioid use and longer length of stay (mean difference, 2.25 days; 95% CI, 1.29-3.22), higher likelihood of prior IBD-related surgery (RR, 1.72; 95% CI, 1.32-2.25), and higher rates of biologic use (RR, 1.38; 95% CI, 1.13-1.68) but no difference in 30-day readmissions (RR, 1.17; 95% CI, 0.86-1.61), immunomodulator use (RR, 1.13; 95% CI, 0.89-1.44), or corticosteroid use (RR, 1.36; 95% CI, 0.88-2.10) in patients with IBD. On systematic review, opioid use was associated with increased hospitalizations, healthcare costs, emergency department visits, outpatient visits, and polypharmacy.

Discussion: Opioids use among patients with IBD is associated with increased healthcare utilization. Nonopioid alternatives are needed to reduce burden on the healthcare system and improve patient outcomes.