Opioid Use Disorder Among U.S. Hospitalizations for Dorsalgia: A National Inpatient Sample Analysis, 2016–2021

Karan Patel,1 Kyle T Enriquez,2 Tigran Kesayan1,3,41Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA; 2Vanderbilt Medical Scientist Training Program, Vanderbilt University School of Medicine, Nashville, TN, USA; 3Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, 37232, USA; 4Department of Plastic Surgery, Vanderbilt University Medical Center, Nashville, TN, 37232, USACorrespondence: Karan Patel, Department of Neurology Vanderbilt University Medical Center Nashville, TN, USA, Tel +1 732-887-9851, Email [email protected]: Opioid use disorder (OUD) is an important comorbidity in chronic pain. Understanding its association with inpatient outcomes may identify opportunities to improve management and resource utilization.Materials and Methods: We conducted a retrospective, cross-sectional analysis of the National Inpatient Sample on hospitalizations with a primary diagnosis of dorsalgia. Hospitalizations were further categorized based on the presence of OUD. Survey-weighted logistic regression incorporating the complex survey design identified demographic and hospital characteristics associated with OUD. Survey-weighted logistic and linear regression evaluated routine discharge and length of stay, respectively. Rates of discharge against medical advice between hospitalizations with and without OUD was added on as a secondary exploratory analysis.Results: Among 233,740 dorsalgia hospitalizations, 8,540 (3.7%) had OUD. Compared with age < 40 years, ages 40– 59 (OR 0.68, 95% CI 0.59– 0.79), 60– 79 (OR 0.26, 95% CI 0.22– 0.32), and ≥ 80 years (OR 0.09, 95% CI 0.06– 0.11) had lower OUD odds (all P< 0.001). Medicaid was associated with higher odds (OR 1.29, 95% CI 1.11– 1.51; P=0.001), while private insurance (OR 0.39, 95% CI 0.33– 0.47), female sex (OR 0.82, 95% CI 0.74– 0.91), Black (OR 0.59, 95% CI 0.50– 0.69) and Hispanic race (OR 0.50, 95% CI 0.41– 0.61) were all associated with lower odds (all p< 0.001). OUD was associated with lower routine discharge odds (OR 0.62, 95% CI 0.55– 0.70), longer stays (β=0.68 days, 95% CI 0.48– 0.88), and higher rates of discharge against medical advice (8.5% vs 2.1%; p< 0.001).Conclusion: Dorsalgia hospitalizations with OUD were associated with younger age, longer stays, and decreased odds of routine discharge. These findings identify a vulnerable inpatient population and may help to inform evaluation of individualized pain treatment, earlier discharge coordination, and more efficient resource utilization.Keywords: dorsalgia, opioid use disorder, national inpatient sample, age, insurance, chronic pain