Patient-controlled Analgesia For Vaso-Occlusive Crisis: A Cohort Study

Background:Sickle cell disease (SCD) accounts for over 68,000 hospital admissions each year in the United States, 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 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 (odds ratio [OR]_unadj: 0.69; 95% confidence interval [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 against medical advice in Generalized Estimating Equation modeled unadjusted (OR_unadj: 1.10; 95% CI: 0.69-1.76, P=0.68), or adjusted analysis (OR_adj: 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.