Cirrhosis inpatients take more opioids, fewer nonopioid analgesics than noncirrhosis patients

Inpatients normally use analgesics for pain, with comparable rates between those with and without cirrhosis, according to a recent study. Patients with cirrhosis, especially decompensated ones, are less likely to use acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) and more likely to use opioid analgesics.

The Vizient Clinical Database, which includes clinical and billing data from hospitalizations at >500 academic medical centres in the US, was used in this study. The authors identified cirrhosis patients hospitalized in 2017‒2018, as well as a matched cohort of noncirrhosis patients.

The types of analgesic given (ie, acetaminophen, NSAIDs, opioids, and adjuvants such as gabapentinoids and antidepressants) were defined from inpatient prescription records. The authors then assessed the relationship between cirrhosis diagnosis and analgesic use through conditional logistic regression.

Of the 116,363 inpatients with cirrhosis identified, 83 percent received at least one dose of an analgesic, while 58 percent had regular inpatient analgesic use. These rates were clinically comparable to those of noncirrhosis patients.

Cirrhosis inpatients were half as likely to take acetaminophen (26 percent vs 42 percent; p<0.01) or NSAIDs (3 percent vs 7 percent; p<0.01) but were more likely to use opioids (59 percent vs 54 percent; p<0.01), particularly decompensated patients (60 percent), than noncirrhosis controls.

Notably, a significant disparity was seen in analgesic prescribing patterns between hospital, especially among patients with cirrhosis.

“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,” the authors said.