The impact of obesity in patients hospitalized with opioid/opiate overdose

Abstract

Background: Although a direct link between opioid use in obese patients and risk of overdose has not been established, obesity is highly associated with higher risk for opioid/opiate overdose. Evidence for clinical impact of obesity on patients with opioid/opiate overdose is scarce. The aim of this study was to determine effects of obesity on health-care outcomes and mortality trends in hospitalized patients who presented with opioid/opiate overdose in the United States between 2010 and 2014. Design: Multivariate logistic and linear regression analysis compared clinical outcomes and hospital resource utilization between obese and nonobese patients. Trend analysis of in-hospital mortality was also analyzed. Setting: United States. Participants: 302,863 adults ≥ 18 years and hospitalized with a principle diagnosis of opioid/opiate overdoses between 2010 and 2014. Measurements: Primary measurement was in-hospital mortality. Secondary measurements included respiratory failure, cardiogenic shock, mechanical ventilations/intubations, hospital charges, and length of stay. Findings: Prevalence for in-hospital mortality was lower in patients with obesity (2.2% vs 2.9%). Obese patients had higher adjusted odds for respiratory failure (aOR = 1.7, [(CI) 1.6–1.8]) and mechanical ventilation/intubation (aOR = 1.17, [(CI) 1.10–1.2]). They also had longer length of stays (aMD = 0.4 days, [(CI) 0.25–0.58 days] and higher total hospital charges (aMD = $5,561, [(CI) $3,638–$7,483]. Trends of in-hospital mortality for patients with obesity did not significantly increase (2.1% in 2010 to 2.4% in 2014, p trend = 0.37), but significantly increased for obese patients (2.4% in 2010 to 3.4% in 2014; p trend <0.01). Conclusions: Prevalence and trends of mortality were lower in patients with obesity hospitalized for opiate/opioid overdose compared to those without obesity between 2010 and 2014 in the United States.

Keywords:

• Hospitalizations
• hospital mortality
• large database
• obesity
• opioid/opiate overdose
• United States

Ethical approval and consent to participate

The study was not submitted for research ethics approval because the activities described were conducted as part of the National Inpatient Sample (NIS), which is part of the family of databases and software tools developed for the Healthcare Cost and Utilization Project (HCUP) and uses de-identified data collected from hospitalized patients. The study activities obtained from NIS are exempt from the Johns Hopkins’ Institutional Review Board and do not require informed consent. For additional details, please refer to the following website links: www.hopkinsmedicine.org/institutional_review_board/guidelines_policies/guidelines/exempt_research.html; www.ecfr.gov/cgi-bin/retrieveECFR?gp=&SID=83cd09e1c0f5c6937cd9d7513160fc3f&pitd=20180719&n=pt45.1.46&r=PART&ty=HTML#se45.1.46_1104.

Authors’ contributions

PA, CH, and KV were involved in conceptualization for the study and its design. CH and HB contributed to the statistical analysis of the study. PA, CH, and KV all helped in writing and editing the manuscript. All authors reviewed and approved the final manuscript.

Consent for publication

Not applicable.

Disclosure statement

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of Fort Belvoir Community Hospital, the Defense Health Agency, Department of Defense, or US government. Reference to any commercial products within this publication does not create or imply any endorsement by Fort Belvoir Community Hospital, the Defense Health Agency, Department of Defense, or US Government. The authors declare that they have no competing interests.

Data availability statement

Researchers should readily be able to purchase the same databases we did to conduct research here: www.distributor.hcup-us.ahrq.gov/Databases.aspx. The authors did not have special access privileges to the NIS databases. Contact information for further guidance on purchase and download can be found at vog.qrha@rotubirtsiDPUCH.