Abstract Details

Title Long-term Opioid Use in Patients with Aneurysmal Subarachnoid Hemorrhage

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) S61 - Neurocritical Care: Cerebrovascular Disease (2:48 PM-3:00 PM)

Poster/Presentation
Number 010

Objective long term opioids for headache treatment in SAH

Background

Headache and neck pain are common in patients with aneurysmal subarachnoid hemorrhage (aSAH). Because pain is often a sequela, these patients are at risk for opioid dependence. Long term opioid use has not been well studied in this population.

Design/Methods We analyzed a cohort of consecutive patients who were admitted with diagnosis of aSAH to an academic referral center from 2015 to 2018. We excluded patients who died during hospitalization or were discharged to hospice or were previously taking any opioids. The following variables were collected: demographics, any opioid use during hospitalization, short-term low-dose steroid use (mostly for headache management but some cases for immediate post craniotomy for aneurysm clipping), opioid prescription at the time of discharge and 3-month or longer opioid use verified by pharmacy and any follow up out patient records.

Results Of 200 patients with aSAH, 144 patients (72%) met our inclusion criteria. Mean age was 58 years (SD 14.8); Ninety-four patients (65%) were women; All patients received opioids at some point during hospitalization but 66% (96/144) were discharged with opioid prescription. Of these, 31% (30/96) continued to use opioids at ≥3 months. The overall rate of chronic opioid use was 20% (30/144). The rate of opioid prescription at discharge was 72% (52/72) in patients who received short course steroids and 61% (44/72) in patients who did not receive steroids. (p=0.21; OR 2.6, 95% CI 0.82-3.3). Steroids did not prevent long term opioid use. (p=0.30; OR 0.6, 95% CI 0.26-1.3)

Conclusions Opioids are regularly used as the main treatment option for pain control in patients with aSAH. A noteworthy number of patients continue to use opioids beyond their initial hospitalization. Steroid use does not prevent long term opioid use in these patients. Non-opioid pain control strategies should be explored in the future.

Authors/Disclosures
Aidan Azher, MD (UTHealth, McGovern School of Medicine) PRESENTER	Dr. Azher has nothing to disclose.
Matthew Anderson, DO	Dr. Anderson has nothing to disclose.
Katarina B. Dakay, DO (New York Medical College, Westchester Medical Center)	No disclosure on file
Brian Mac Grory, MB BCh BAO (Duke University School of Medicine)	An immediate family member of Dr. Mac Grory has received personal compensation for serving as an employee of Sanofi. Dr. Mac Grory has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke. The institution of Dr. Mac Grory has received research support from National Institutes of Health. The institution of Dr. Mac Grory has received research support from American Heart Association.
Scott Moody	No disclosure on file
Ashutosh Kaushal, MD (UTHealth Neurosciences – Department of Neurology)	No disclosure on file
Bradford B. Thompson, MD (St. Elizabeth’s Medical Center)	Dr. Thompson has nothing to disclose.
Linda C. Wendell, MD, FAAN (Mount Auburn Hospital)	Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. An immediate family member of Dr. Wendell has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Various. Dr. Wendell has stock in Apple. An immediate family member of Dr. Wendell has stock in Apple.
Shyam S. Rao, MD (Rhode Island Hospital, Brown University)	No disclosure on file
Nicholas S. Potter, MD, PhD (Rhode Island Hospital)	Dr. Potter has nothing to disclose.
	No disclosure on file
Shawna M. Cutting, MD, FAAN	The institution of Dr. Cutting has received research support from Genentech.
Michael Reznik, MD (Rhode Island Hospital)	Dr. Reznik has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Morrison Mahoney. The institution of Dr. Reznik has received research support from NIDUS.
Shadi Yaghi, MD	Dr. Yaghi has nothing to disclose.
Karen L. Furie, MD (RIH/Alpert Medical School of Brown Univ)	The institution of Dr. Furie has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Janssen/BMS. Dr. Furie has received personal compensation in the range of $50,000-$99,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for BMJ/JNNP. The institution of Dr. Furie has received research support from NINDS.
Ali Mahta, MD (Brown University)	Dr. Mahta has nothing to disclose.

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