[Research summary] New Research Review Looks at Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain

From the AHRQ Web site

A new research review from AHRQ’s Effective Health Care Program  found that while the evidence on the effectiveness and harms of opioid therapy for chronic pain treatment is limited, there is an increased risk of serious harms based on the opioid dose given. The research review assesses observational studies that suggest that use of long-term opioids for chronic pain is associated with increased risk of abuse, overdose, fractures and heart attack, when compared with patients who are not being prescribed opioids. The review noted that more research is needed to understand the long-term benefits, risk of abuse and related outcomes, and effectiveness of different opioid prescribing methods and strategies. The review is titled, “The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain.” AHRQ has also released a statistical brief from the Healthcare Cost and Utilization Project titled, “Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993-2012.” According to the brief, hospitalization rates for opioid overuse more than doubled from 1993 to 2012 and increased at a faster rate for people age 45 and older. In addition, AHRQ Director Rick Kronick, Ph.D., has published a blog about opioids.

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[Infographic] The Top Five Most Expensive Conditions Treated in US Hospitals, 2011

From the Agency for Healthcare Research and Quality

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[Repost] Most Frequent Procedures Performed in U.S. Hospitals, 2011

From Statistical Brief #165 at Healthcare Cost and Utilization Project (HCUP)

Anne Pfuntner, Lauren M. Wier, M.P.H., and Carol Stocks, R.N., M.H.S.A. Introduction When hospitalized, patients may undergo procedures for surgery, treatments (e.g., blood transfusions), or for diagnostic purposes (e.g., biopsy). The principal procedure is the procedure performed for definitive treatment. Hospitalizations usually involve multiple procedures, which together constitute the all-listed procedures performed during a hospital stay. Data on inpatient hospital procedures can help hospital administrators, health practitioners, researchers, and others understand how hospital care, including care related to diagnosis and treatment, is currently provided and what changes or consistencies in care delivery have occurred over time. The present Statistical Brief presents 2011 data on the most common all-listed procedures performed during hospital stays in the United States, overall and by patient age. Changes between 1997 and 2011 in the number of stays and in the rate of hospitalizations with these procedures are also presented. All differences between estimates noted in the text are statistically significant at the .001 level or better. Findings Most frequent all-listed procedures performed during hospital stays, 2011 Table 1 shows the all-listed procedures that were performed most commonly during hospital stays in 2011, as well as the change in the rate of hospitalizations with these procedures since 1997. Procedures were performed in 63 percent of hospital stays in 2011. The hospitalization rate for stays with procedures remained stable since 1997 at 780 per 10,000 population. Blood transfusion was the most common procedure performed during hospitalizations in 2011 (12 percent of stays with a procedure); the rate of hospitalizations with blood transfusion more than doubled since 1997. Respiratory intubation and mechanical ventilation was the third most common procedure performed, occurring in 7 percent of stays with a procedure in 2011. The hospitalization rate for stays involving respiratory intubation and mechanical ventilation increased 56 percent since 1997.

Highlights Procedures were performed in 63 percent of hospital stays in 2011.The hospitalization rate for stays with procedures remained stable since 1997 at 780 per 10,000 population. Between 1997 and 2011, the hospitalization rate for stays with hemodialysis increased 68 percent. The hospitalization rates for stays with a blood transfusion increased 129 percent for adults aged 18-44 years and 45-64 years, 111 percent for adults aged 65-84 years, and 97 percent for adults aged 85 years and older. The hospitalization rate for stays with Cesarean section increased 39 percent between 1997 and 2011. Between 1997 and 2011, the most rapidly growing procedure was indwelling catheter—the rate of hospitalization for stays with this procedure more than tripled. Adults aged 65-84 years accounted for more than half of the total number of stays with knee arthroplasty in 2011; their hospitalization rate increased 59 percent since 1997.

Six of the most frequent procedures performed were associated with pregnancy, childbirth, and newborns. When combined, they accounted for 30 percent of stays with a procedure in 2011: prophylactic vaccinations and inoculations, repair of current obstetric laceration, Cesarean section, circumcision, artificial rupture of membranes to assist delivery, and fetal monitoring. Cesarean section was the most common major operating room procedure performed in 2011 (41 stays per 10,000 population); the hospitalization rate for stays with Cesarean section increased 39 percent since 1997. Four cardiovascular procedures also were among the most frequently performed in 2011, constituting almost 15 percent of all stays with a procedure: diagnostic cardiac catheterization, coronary arteriography; hemodialysis; diagnostic ultrasound of the heart (echocardiogram); and percutaneous transluminal coronary angioplasty (PTCA). Between 1997 and 2011, the hospitalization rate for stays with hemodialysis increased 68 percent, but the rate fell 24 percent for stays with diagnostic cardiac catheterization.

Table 1. Number of stays, stays per 10,000 population, and percentage change in rate of the most frequent all-listed procedures for hospital stays, 1997 and 2011
All‐listed Clinical Classifications Software (CCS) procedures	Number of stays with the procedure in thousands		Number of stays with the procedure per 10,000 population		Change in rate, %
	1997	2011	1997	2011	1997-2011
All stays (with and without procedures)	34,679	38,591	1,272	1,239	-3
All stays with any procedure	21,257	24,312	780	780	0
Stays with a procedure, %	61	63
Blood transfusion*	1,097	2,929	40	94	134
Prophylactic vaccinations and inoculations	567	1,860	21	60	187
Respiratory intubation and mechanical ventilation	919	1,635	34	52	56
Repair of current obstetric laceration	1,137	1,315	42	42	1
Cesarean section	800	1,272	29	41	39
Diagnostic cardiac catheterization, coronary arteriography	1,461	1,261	54	40	-24
Upper gastrointestinal endoscopy, biopsy	1,105	1,225	41	39	-3
Circumcision	1,164	1,108	43	36	-17
Artificial rupture of membranes to assist delivery	747	948	27	30	11
Hemodialysis	473	909	17	29	68
Diagnostic ultrasound of heart (echocardiogram)	632	869	23	28	20
Fetal monitoring	1,002	780	37	25	-32
Arthroplasty knee	329	718	12	23	91
Enteral and parenteral nutrition	277	586	10	19	85
Percutaneous transluminal coronary angioplasty (PTCA)	581	560	21	18	-16
Colonoscopy and biopsy	531	525	19	17	-13
Laminectomy, excision intervertebral disc	425	525	16	17	8
Spinal fusion	202	489	7	16	112
Incision of pleura, thoracentesis, chest drainage	349	476	13	15	19
Hip replacement, total and partial	291	467	11	15	40
* The number of stays with blood transfusion does not reflect the number of units of blood transfused. Source: Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS), 1997 and 2011

 

 

 

 

Read the entire report here

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