A national analysis of the impact of opioid use disorder on clinical outcomes in hospitalized patients with urothelial carcinoma.

Abstract

659 Background: Patients with urothelial carcinoma often require hospitalizations for peri and post operative management of major surgical interventions, such as cystectomies and nephroureterectomies, and disease complications. Opioid use disorder (OUD) is a growing public health issue with well-established adverse outcomes; however, there is minimal literature with regards to the intersection of OUD and urothelial carcinoma. Here we investigate the associations of OUD with clinical outcomes in hospitalized patients with urothelial carcinoma. Methods: We conducted a cross-sectional study using the 2018 National Inpatient Sample among adult (age > 18 years) hospitalizations with urothelial carcinoma. Descriptive data was used to compare demographic and clinical characteristics of patients with and without OUD. Clinical outcomes were identified with ICD-10-CM codes. The Charlson Comorbidity Index (CCI) was used to calculate comorbidities. Multivariable logistic regression was used to evaluate the association between OUD and clinical outcomes, adjusting for demographics, comorbidities, metastatic disease, type of admission, hospital location and other clinical risk factors. Survey weights were applied to generate national estimates. Results: Among 93,040 weighted hospitalizations, 830 (0.9%) involved OUD. Patients with OUD tended to be younger (mean age 66.0 vs 73.4 years), African American (13.3% vs 7.7%), have higher rates of Medicaid insurance (14.5% vs. 5.6%), increased length of stay (5 days vs 4 days), and have metastatic disease (41.0% vs 24.3%) compared to non-OUD hospitalizations (all p < 0.005). However, there was no significant difference with regards to urothelial surgery (p = 0.629). After adjustment, OUD was independently associated with increased odds of hospitality mortality (aOR 1.75, 95% 1.11-2.77), sepsis, (aOR 1.30, 95% 1.06-1.59), and venous thrombosis (aOR 1.52, 95% 1.10-2.10). Conclusions: In this nationally represented sample of hospitalized patients with urothelial carcinoma, OUD was associated with sociodemographic disparities and worse clinical outcomes. Patients with OUD were more likely to belong to a minority population and present at a later stage in disease process. After adjustment for possible cofounders, OUD was independently associated with increased odds of hospital mortality, sepsis, and venous thrombosis.