S005: "IMPACT OF COVID-19 INFECTION ON CLINICAL OUTCOMES IN PATIENTS HOSPITALIZED FOR OPIOID OVERDOSE: IMPLICATIONS FOR PERIOPERATIVE AND CRITICAL CARE MANAGEMENT"
Benjamin Gerstein; Kori Brewer; Dmitry Tumin; Jason Hack
East Carolina University
Introduction/Background: The intersection of opioid overdose and COVID-19 presents unique challenges for anesthesiologists involved in perioperative and critical care. To date, research on opioid overdose during the COVID-19 pandemic has focused on rates of Emergency Department (ED) visits related to opioids but has not considered how interaction with concurrent COVID-19 infection may have influenced clinical outcomes. We hypothesized that COVID-19 infection increased the use of respiratory support, prolonged hospital stays, and increased mortality among ED patients admitted to the hospital after presenting with opioid overdose.
Methods: The 2020 National Emergency Department Sample (NEDS) was used to identify patients admitted to the hospital after presenting to the ED with opioid overdose, and whose COVID-19 infection status could be determined. The primary outcome was the use of respiratory support, and secondary outcomes were hospital length of stay (LOS) and mortality.
Results: Among the 5,913 eligible patients, 3% had a COVID-19 infection diagnosis. Among all included patients, 28% received respiratory support, in-hospital mortality was 4%, and the mean hospital length of stay was 3.9 days. After multivariable adjustment, COVID-19 was not associated with the use of respiratory support (odds ratio [OR]: 0.98; 95% confidence interval [CI]: 0.67, 1.44; p=0.938). COVID-19 was associated with higher odds of in-hospital mortality (OR: 2.22; 95% CI: 1.20, 4.11; p=0.011) and longer hospital stay (incidence rate ratio: 1.57, 95% CI: 1.22, 2.01; p<0.001).
Discussion/Conclusion: This data suggests that COVID-19 infection in patients admitted to the hospital with opioid overdose results in higher morbidity and longer hospital stay, but had no association with the use of respiratory support. These findings challenge assumptions about the additive effects of COVID-19 and opioid-induced respiratory depression, highlighting the need for further investigation into the pathophysiology and anesthetic management of these patients.