Patients with cirrhosis are more likely to receive opioids and less likely to receive other analgesics compared with patients without cirrhosis, although the rate of analgesic use was similar, according to study findings published in Journal of Clinical Gastroenterology.
Researchers at the University of California in San Francisco conducted a retrospective cohort study from January 1, 2017, to December 31, 2018, and obtained data using the Vizient Clinical Data Base/Resource Manager from 3000 hospitals across the United States.
They studied analgesic use among 116,363 inpatients aged 18 years or older with cirrhosis compared with 116,363 matched control inpatients without cirrhosis across 205 hospitals. Among the inpatients with cirrhosis, 82.6% received at least 1 analgesic dose, while 58.4% received regular inpatient analgesic doses.
Inpatients without cirrhosis demonstrated similar rates of analgesic use. In fact, patients with cirrhosis were 14% less likely to receive analgesics (odds ratio [OR], 0.86; P <.01) and 12% less likely to receive regular analgesic doses (OR, 0.88; P <.01) than those without cirrhosis.
In contrast, initiation of a new analgesic treatment occurred 42% more frequently among patients with cirrhosis during hospital admission than those without cirrhosis (OR, 1.42; P <.01).
When analyzing types of analgesic used, patients with cirrhosis were around half as likely to receive acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) than those without cirrhosis (26% vs. 42%; P <.01 and 3% vs. 7%; P <.01, respectively). Conversely, patients with cirrhosis more likely received opioids (59% vs. 54%; P <.01), especially patients with hepatic decompensation (60%).
The study is limited by the lack of information on medication dosage, the lack of a comprehensive list of preadmission outpatient medications, hospital policies and default electronic order sets influencing decision-making, and the inability to determine characteristics such as the nature and severity of pain.
The study authors conclude, “Because of lack of evidence-based guidance for management of cirrhosis patients with pain, providers may avoid nonopioid analgesics due to perceived risks and consequently may overutilize opioids in this high-risk population.”