Hospitalized overdose patients sicker, costlier, more likely to die

In what is believed to be the first effort to quantify the opioid crisis's national impact on critical care resources, researchers this week portrayed an overdose victim population with increasingly greater care needs and a growing death rate.

The research team from three institutions suggests that the transition to heroin use from prescription opioids has contributed greatly to the increased need for critical care support in recent years. They reported that the average cost per intensive-care overdose admission rose from around $58,500 in 2009 to more than $92,000 in 2015, adding that services such as dialysis are being required more frequently.

“We would propose that any admission to the ICU for opioid overdose is a preventable admission,” wrote the researchers from Harvard Medical School, the University of Chicago and Ben-Gurion University of the Negev in Israel. They added that “these findings represent a growing and urgent call for additional critical care resources and expanded primary prevention strategies.”

Study summary

The study, published online this week in the Annals of the American Thoracic Society, looked at hospitalized patients at 162 facilities in 44 states, examining the population discharged between Jan. 1, 2009 and Sept. 30, 2015. Overdose admissions were defined as including any patient with a diagnostic code for prescription drug overdose, heroin overdose, or methadone overdose.

The researchers examined trends in intensive-care admissions for opioid-related overdose, in-hospital death rates, use of resources such as mechanical ventilation and renal replacement therapy, rates of other health complications from opioid overdose, and overall costs.

They found that the incidence of opioid overdose patients admitted to the ICU increased significantly per month per year over the study period. The average mortality rate for this group was 7.3%, but in the final year of the analysis the rate had increased to 9.81%.

The need for renal replacement therapy was 37% more prevalent in 2015 than in 2009, the researchers reported. One-quarter of overdose patients who were admitted to intensive care experienced aspiration pneumonia.

“Although our data are not definitive, they suggest that overdoses from heroin, rather than prescription opioids, appear to be a major contributor to the rise in critical care mortality for this population,” study authors wrote.

Also of concern is that these overall numbers might actually underestimate the extent of the problems. “Since our team of researchers analyzed admissions rather than a manual chart review, we may not have captured every admission if opioid-related complications weren't coded as such,” researcher Lena Novack, PhD, a lecturer at Ben-Gurion University's School of Public Health, said in an Aug. 28 news release.

The researchers also analyzed some state-by-state trends for states with more than five hospitals reporting data over the entire study period, finding higher-than-average growth in ICU admissions in Massachusetts and Indiana. Pennsylvania saw the steepest increase in opioid-related overdoses over the course of the study period.

Recommendations

The research team did not take a position on whether the increases in critical care admissions are more a result of better work by emergency response teams in rescuing overdose victims in the community or a reflection of a failure to offer more immediate care that could forestall crisis scenarios.

They wrote that the early recognition of the need for critical care resources “may allow for early action in these areas to both prepare critical care units for the needs of this population and to better equip front line providers to prevent these critical care admissions from occurring.”