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Publication Date

3-22-2024

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Presentation: 6:22

Slides attached as supplemental file below

Abstract

The rise in hospitalization, linked to increased infections from injection drug use (IDU), necessitates effective post-acute care measures and medication for opioid use disorder (MOUD) to mitigate extended hospital stays and preventable complications. However, the lack of resources for patients who use drugs (PWUD) in post-acute care settings presents a significant challenge.

The objective is to analyze how differences in substance use disorder affect length of stay and discharge patterns among hospitalized patients with similar IDU-related infections and co-morbidities. We use a secondary analysis of 2017 to 2023 hospital data for patients with IDU-related infections (infective endocarditis, epidural abscess, septic arthritis, osteomyelitis, and skin and soft tissue infections) performed using univariate and bivariate regression analyses to compare the length of stay and discharge outcomes across four substance use categories: neither opioid nor stimulant use, only opioid-use, only stimulant-use, and both opioid- and stimulant use.

Of the 206,876 qualifying hospitalizations, 87.4% had no documented opioid/stimulant use (n =180,810). Yet, there were substantial numbers of hospitalizations coinciding with opioid use (N=14,490;7.0%), stimulant use (N=4,726; 2.3%), and both (N=6,850; 3.3%). Opioid use and opioid and stimulant use were associated with substantially longer hospital lengths of stay and with fewer discharges to post-acute care after adjusting for demographic and other factors. This patterning grew worse over the period, in parallel with significant increases in patient-directed discharge patients with opioid use and opioid and stimulant use. It is essential to improve MOUD capacity by and post-discharge to reduce the length of hospital stays and patient-directed discharge among PWUD, address this public health priority, and mitigate numerous preventable harms.

Lay Summary

More people are going to the hospital because they get sick from using needs to take drugs. When they leave the hospital, they need special care and medicine to help them stop using drugs like opioids, but sometimes, these medicines and care are not available. This makes it hard for them to get better and often means they must stay in the hospital longer. We wanted to find out if people who use different kinds of drugs remain in the hospital for various amounts of time and what happens to them when they leave the hospital. To do this, we looked at hospital records from 2017 to 2023 for people who got sick because of using their needles to inject drugs. We focused on five kinds of infections that are common in these patients. We then compared how long they stayed in the hospital and where they went afterward based on whether they used opioids, stimulants (like methamphetamines and cocaine), both, or neither.

We found that out of the 206,876 people who went to the hospital for these infections, most of them did not use opioids or stimulants. But a good number did use these drugs. People who used opioids or both opioids and stimulants had to stay in the hospital for longer and had a more challenging time getting the care they needed after leaving the hospital. As a result, more people leave the hospital before they should, which is unsafe.

It is crucial to make sure patients who use drugs can get the right medicine and care after they leave the hospital. This can help them get better faster and avoid going back to the hospital for the same reason. Making sure people who use drugs get the help they need after they leave is a big step towards taking care of everyone’s health.

Additional Files
20240321_Lin_Stephanie_slides.pdf (649 kB)

Language

English

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