P-088 - Significance of Morphine Milligram Equivalents in the 5 Days Prior to Acute Inpatient Rehabilitation Stay

Abstract Title: Significance of Morphine Milligram Equivalents in the 5 Days Prior to Acute Inpatient Rehabilitation Stay

Background: Many individuals require opiate medications in the acute hospital setting. Most patients come to acute inpatient rehabilitation (AIR) post-operatively and have pain managed with intravenous and as needed opiates in the acute setting. Prior to AIR, patients are most often transitioned to oral pain regimens but frequently require pain medications as their activity is increased in the AIR setting. Opiate medications have been shown to cause longer hospitalizations, increased readmissions and complications in older populations, surgical populations, and trauma patients. Research on whether opiate medications have an effect of AIR populations is limited and inconclusive.

Purpose/Objectives: Our objective was to determine the significance of opioids on outcomes in acute inpatient rehabilitation. Do patients who receive large amounts of opioids in the days prior to AIR have increased length of stay in AIR or increased complications? Do we need to be more conscious of the amount of pain medication utilized in a patient’s care prior to them being admitted to AIR?

Methods: This study was a retrospective cohort study of adult patients from University of North Carolina (UNC) hospitals from May 2022 to November 2022. The analysis was restricted to patients 18-65 in age who were admitted to UNC AIR hospitals from May 01, 2022 to November 30, 2022. A prior history of opiate abuse or dependence and patients who came to AIR from non-UNC affiliated hospitals met exclusion criteria. Data was analyzed using multivariable linear regression to compare outcome measures of length of stay, 90 day readmission and discharge disposition with MME in the 5 day period prior to AIR. Additional analysis performed to determine differences in length of stay between patients who took < 30mme/day in 5 days prior to rehab and ≥30mme/day in 5 days prior was done using a two tailed T test.

Results: A total of 235 patients had data abstracted and validated for inclusion in the study from 291 patients in the cohort. The mean age of patients was 50.5 years. 42% of patients analyzed were female. On average patients receiving ≥30mme/day prior to AIR were in acute inpatient rehab for 1 day more when compared to the group < 30mme/day prior to AIR (95% CI 12.7 - 16.2). Mean length of stay was 14.9 days in AIR. Multivariable linear regression of MME in the 5 days prior to admission to AIR on length of stay (p >0.05), disposition from rehab (p >0.05) and 90 day readmission (p >0.05).

Conclusions/Implications for future research and/or clinical care: MME in the days before AIR has no statistical significance on outcomes related to length of stay, 90 day readmission or disposition at discharge. The cohort was a small size and limited in age – encouraging further investigation with a large cohort and broader age range. Many factors such as ability to get into the home and access to durable medical equipment (DME) may contribute to these outcome measures and further research is needed to investigate this.

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