Hydroxyurea and acute painful crises in sickle cell anemia: Effects on hospital length of stay and opioid utilization during hospitalization, outpatient acute care contacts, and at home

Authors

Samir K. Ballas, MD, FACP, Thomas Jefferson UniversityFollow
Robert L. Bauserman, PhD, Maryland Medical Research InstituteFollow
William F. McCarthy, PhD, Maryland Medical Research Institute
Oswaldo L. Castro, MD, Howard University
Wally R. Smith, MD, School of Medicine, Virginia Commonwealth University
Myron A. Waclawiw, PhD, National Heart, Lung and Blood InstituteFollow

Document Type

Article

Publication Date

12-2010

Comments

This article has been peer reviewed. It is the authors' final version prior to publication in Journal of Pain and Symptom Management Volume 40, Issue 6, December 2010, Pages 870-882. The published version is available at DOI: 10.1016/j.jpainsymman.2010.03.020. Copyright © Elsevier Inc.

Abstract

Recurrent acute sickle cell painful crises are the hallmark of sickle cell anemia. These events may be mild, moderate or severe in nature and often require treatment at home, in acute care facilities as outpatients, and in the hospital with oral and/or parenteral opioids. The type, dose, route & frequency of administration of opioids, as well as the length of hospital stay (LOS), are not well known for adults with sickle cell anemia (SS). We analyzed these aspects in the 299 patients enrolled in the Multicenter Study of Hydroxyurea (MSH) in SS. For these patients there were 16818 home diaries, 2249 acute care contacts, and 2209 hospitalizations. At home analgesics were used on 40% of diary days and 80% of 2-week follow up periods, with oxycodone and codeine the most frequently used. Responders to hydroxyurea (HU) used analgesics on fewer days. During hospitalization 96% were treated with parenteral opioids, with meperidine the most frequently used; oxycodone was the most commonly used oral medication. The average LOS for responders to HU was about two days less than for other groups and their cumulative time hospitalized during the trial was significantly less than for nonresponders or placebo groups (p<0.022). They also had the lowest doses of parenteral opioids during acute care crises (p=.015).

Recommended Citation

Ballas, MD, FACP, Samir K.; Bauserman, PhD, Robert L.; McCarthy, PhD, William F.; Castro, MD, Oswaldo L.; Smith, MD, Wally R.; and Waclawiw, PhD, Myron A., "Hydroxyurea and acute painful crises in sickle cell anemia: Effects on hospital length of stay and opioid utilization during hospitalization, outpatient acute care contacts, and at home" (2010). Department of Medicine Faculty Papers. Paper 52.
https://jdc.jefferson.edu/medfp/52