P1609 - Opioid Use for IBD Flare in the Emergency Department: A Retrospective Study in a Tertiary Care Hospital

Steven Park, MD¹, Edwin Lee, MD¹, Krystle Bittner, MPH², Nicole Acquisto, PharmD¹, Srinidhi Venkatesh, ², Phoebe Huang, ², Michael Meadow, ², Arthur DeCross, MD¹, Danielle Marino, MD^1
1University of Rochester Medical Center, Strong Memorial Hospital, Rochester, NY; ²University of Rochester Medical Center, Rochester, NY

Introduction: Opioid use is associated with increased mortality, emergency department (ED) utilization, 30-day readmission rates and decreased quality-of-life (QOL) in patients with inflammatory bowel disease (IBD). Opioid use in the ED for acute IBD presentations has not been well characterized in the literature. Therefore, we performed a single-center retrospective study to determine the rate of ED opioid prescribing for IBD flares.

Methods: This was an IRB-approved retrospective, observational, study from June 1^st to December 31^st, 2019 at our academic tertiary-care center. Consecutive adult patients who presented to the ED with an IBD flare [defined as having either cross-sectional imaging or endoscopic evidence of intestinal inflammation in the setting of primary IBD symptoms] with documented pain were eligible for inclusion. Patients with IBD-related surgery in the past 3 months or complications requiring emergent surgery during ED course were excluded. The primary outcome was opioid administration in the ED. The medical record was used to collect patient demographic data and analgesic prescription, including upon discharge. Descriptive statistics are presented.

Results: A total of 71 patients (mean age 42 years ± 18,50.7% females,63.4% Crohn’s disease,37% ulcerative colitis) were included. Three (4%) patients were chronic opioid users (≥ 30d opioid prescription prior to presentation) and outpatient psychiatric medications were prescribed in 30% of patients. ED pain management characteristics are summarized in Table 1. Patients self-reported a median (IQR) pain score of 5.66 (3-7.33) on the 10-point numeric pain rating scale . Opioids were administered to 55 (78%) patients (most often IV hydromorphone or IV morphine) and an average of 26 morphine-milligram-equivalents (MME) were administered per day in ED. Approximately half (9%) of patients did not receive any non-opioid analgesics. Eleven percent were discharged from the ED or hospital with an opioid prescription that were previously opioid naïve.

Discussion: Almost 80% of patients were prescribed opioids for pain control during ED presentation for IBD flare, while only half of patients received multimodal pain management with non-opioid analgesics. Also concerning was the high rate of prescribing of opioids at ED/hospital discharge (11%). Safe, evidence-based, and effective pain management pathways are needed to promote opioid stewardship in the ED.


Disclosures:


Steven Park, MD¹, Edwin Lee, MD¹, Krystle Bittner, MPH², Nicole Acquisto, PharmD¹, Srinidhi Venkatesh, ², Phoebe Huang, ², Michael Meadow, ², Arthur DeCross, MD¹, Danielle Marino, MD¹. P1609 - Opioid Use for IBD Flare in the Emergency Department: A Retrospective Study in a Tertiary Care Hospital, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.