Patient Controlled Analgesia for Vaso-occlusive Crisis: A Cohort Study

Yelena Averbukh, Andrea Porrovecchio, William N. Southern

Research output: Contribution to journalArticle

Abstract

Background: Sickle cell disease (SCD) accounts for over 68,000 hospital admissions each year in the US, with long inpatient length of stays (LOS) and frequent readmission common. Patient controlled analgesia (PCA) has been used to treat patients admitted with vaso-occlusive crisis (VOC), but it is unknown if PCA is associated with shorter LOS and reduced risk of readmission. Methods: We examined all admissions for acute VOC treated with parenteral opioids to an urban, academic health system over 3 years. We compared LOS, 30-day readmission, and discharges against medical advice (AMA) between admissions treated with PCA versus standard therapy in unadjusted and adjusted analyses using generalized estimating equations to adjust for demographic and clinical characteristics. Results: Of 823 admissions included, 536 (65.1%) were treated with PCA and 287 (34.9%) were treated with standard nurse administered opioid therapy. Treatment with PCA was associated with significantly shorter LOS in the unadjusted analyses (7.46 vs. 9.42 d, P=0.001), but the difference was not significant after adjustment (adjusted difference: 1.47 d, P=0.06). Treatment with PCA was also associated with significantly decreased risk of 30-day readmission in unadjusted analysis (OR unadj 0.69; 95% CI: 0.54-0.89, P=0.004), but after adjustment the association was no longer significant (OR adj 0.76; 95% CI: 0.54-1.06, P=0.11). Finally, treatment with PCA was not associated with increased risk of discharge AMA in GEE modeled unadjusted (OR unadj: 1.10; 95% CI: 0.69-1.76, P=0.68), or adjusted analysis (ORadj 1.19; 95% CI: 0.73-1.94, P=0.49). Conclusions: Treatment with PCA may be associated with shorter LOS, and may be considered as the primary modality for opioid-based pain control for patients with SCD who are admitted with painful VOC.

Original languageEnglish (US)
JournalClinical Journal of Pain
DOIs
StatePublished - Jan 1 2019

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Patient-Controlled Analgesia
Cohort Studies
Length of Stay
Opioid Analgesics
Social Adjustment
Sickle Cell Anemia
Therapeutics
Urban Health
Inpatients
Nurses
Demography
Pain

Keywords

  • patient controlled analgesia
  • sickle cell disease
  • vaso-occlusive painful crisis

ASJC Scopus subject areas

  • Clinical Neurology
  • Anesthesiology and Pain Medicine

Cite this

Patient Controlled Analgesia for Vaso-occlusive Crisis : A Cohort Study. / Averbukh, Yelena; Porrovecchio, Andrea; Southern, William N.

In: Clinical Journal of Pain, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Background: Sickle cell disease (SCD) accounts for over 68,000 hospital admissions each year in the US, with long inpatient length of stays (LOS) and frequent readmission common. Patient controlled analgesia (PCA) has been used to treat patients admitted with vaso-occlusive crisis (VOC), but it is unknown if PCA is associated with shorter LOS and reduced risk of readmission. Methods: We examined all admissions for acute VOC treated with parenteral opioids to an urban, academic health system over 3 years. We compared LOS, 30-day readmission, and discharges against medical advice (AMA) between admissions treated with PCA versus standard therapy in unadjusted and adjusted analyses using generalized estimating equations to adjust for demographic and clinical characteristics. Results: Of 823 admissions included, 536 (65.1{\%}) were treated with PCA and 287 (34.9{\%}) were treated with standard nurse administered opioid therapy. Treatment with PCA was associated with significantly shorter LOS in the unadjusted analyses (7.46 vs. 9.42 d, P=0.001), but the difference was not significant after adjustment (adjusted difference: 1.47 d, P=0.06). Treatment with PCA was also associated with significantly decreased risk of 30-day readmission in unadjusted analysis (OR unadj 0.69; 95{\%} CI: 0.54-0.89, P=0.004), but after adjustment the association was no longer significant (OR adj 0.76; 95{\%} CI: 0.54-1.06, P=0.11). Finally, treatment with PCA was not associated with increased risk of discharge AMA in GEE modeled unadjusted (OR unadj: 1.10; 95{\%} CI: 0.69-1.76, P=0.68), or adjusted analysis (ORadj 1.19; 95{\%} CI: 0.73-1.94, P=0.49). Conclusions: Treatment with PCA may be associated with shorter LOS, and may be considered as the primary modality for opioid-based pain control for patients with SCD who are admitted with painful VOC.",
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AB - Background: Sickle cell disease (SCD) accounts for over 68,000 hospital admissions each year in the US, with long inpatient length of stays (LOS) and frequent readmission common. Patient controlled analgesia (PCA) has been used to treat patients admitted with vaso-occlusive crisis (VOC), but it is unknown if PCA is associated with shorter LOS and reduced risk of readmission. Methods: We examined all admissions for acute VOC treated with parenteral opioids to an urban, academic health system over 3 years. We compared LOS, 30-day readmission, and discharges against medical advice (AMA) between admissions treated with PCA versus standard therapy in unadjusted and adjusted analyses using generalized estimating equations to adjust for demographic and clinical characteristics. Results: Of 823 admissions included, 536 (65.1%) were treated with PCA and 287 (34.9%) were treated with standard nurse administered opioid therapy. Treatment with PCA was associated with significantly shorter LOS in the unadjusted analyses (7.46 vs. 9.42 d, P=0.001), but the difference was not significant after adjustment (adjusted difference: 1.47 d, P=0.06). Treatment with PCA was also associated with significantly decreased risk of 30-day readmission in unadjusted analysis (OR unadj 0.69; 95% CI: 0.54-0.89, P=0.004), but after adjustment the association was no longer significant (OR adj 0.76; 95% CI: 0.54-1.06, P=0.11). Finally, treatment with PCA was not associated with increased risk of discharge AMA in GEE modeled unadjusted (OR unadj: 1.10; 95% CI: 0.69-1.76, P=0.68), or adjusted analysis (ORadj 1.19; 95% CI: 0.73-1.94, P=0.49). Conclusions: Treatment with PCA may be associated with shorter LOS, and may be considered as the primary modality for opioid-based pain control for patients with SCD who are admitted with painful VOC.

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