The national burden of opoid use disorder on hospital outcomes in sickle cell disease: A database review and analysis

Abstract Introduction: Sickle cell disease (SCD) affects approximately 100,000 individuals in the U.S. and frequently leads to hospitalizations for complications like vaso-occlusive crisis. Opioids are central to acute pain management but raise concerns due to adverse effects and prescribing variability, placing them at risk for opioid use disorder (OUD). However, the impact of OUD on hospital outcomes in SCD remains unclear. This study seeks to evaluate the association between OUD in SCD and healthcare outcomes. Methods: An analysis was conducted using the National Inpatient Sample database from 2016 to 2021 to identify adult patients hospitalized with SCD. Patients were stratified based on the presence or absence of a comorbid OUD. Multivariable logistic regression was used to assess the association between OUD and inpatient outcomes, including mortality and acute chest syndrome (ACS). Linear regression analyzed variations in total hospital charges and length of stay (LOS). The models were adjusted for patient demographics (age, gender, race, median household income), Charlson Comorbidity Index and hospital characteristics (region, teaching status, bed size). Results: Among 928,485 SCD hospitalizations, 53,715 (5.8%) had comorbid OUD. Patients with OUD were often male (41.9% vs. 31.8%), younger (34years vs 36years) and insured by Medicaid (37.9% vs. 25.6%) compared to those without OUD. After multivariable adjustment, OUD was not significantly associated with inpatient mortality (OR 0.85; 95% CI: 0.64-1.12, p=0.24). However, patients with OUD had significantly higher odds of developing ACS (aOR 1.21; 95% CI: 1.11-1.33, p<.01). Additionally, OUD was associated with a significant increase in total hospital charges (adjusted coefficient $6,456.24; 95% CI $4,737.53-$8,174.95, p<.01) and a longer LOS (adjusted coefficient 1.65 days; 95% CI 1.48-1.81, p<.01). Discussion: Pain is subjective and influenced by psychosocial factors, although there are validated tools to quantify pain more objectively. The use of opioids to alleviate pain in SCD patients is the cornerstone of disease management. In addition, opioid medication can cause tolerance, meaning escalated doses are required to control pain. These pose challenges to diagnosing OUD in SCD cell patients. Thus, the presence of OUD in SCD may be overlooked, which might have contributed to prolonged hospital stays. Conclusion: In our study, there is a statistically significant association between the comorbid (OUD) and the higher risk of development of (ACS), prolonged hospital stays along with increased healthcare expense while no statistically significant association is noted in terms of mortality. The findings pointed out an overall negative health outcome with the presence of OUD in hospitalized SCD patients, emphasizing the need for targeted interventions to prevent OUD. Early recognition and timely intervention of (OUD) along with judicious use of opioid to manage pain crises are the key steps in improving health outcomes.