Return Rates for Opioid Versus Non-Opioid Management of Patients with Abdominal Pain in the Emergency Department



      Research suggests that opioid treatment for abdominal pain, which comprises a large proportion of patients presenting to the emergency department (ED), may contribute to long-term opioid use without significant benefits with regard to symptom management.


      This study seeks to assess the association between opioid use for management of abdominal pain in the ED and return ED visits for abdominal pain within 30 days for patients discharged from the ED at initial presentation.


      We conducted a retrospective, multi-center observational study of adult patients presenting to and discharged from 21 EDs with a chief concern of abdominal pain between November 2018 and April 2020. The proportion of 30-day return visits to the ED for patients who received opioid analgesics was compared to a reference group of patients who only received acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), or both.


      Of the 4,745 patients, 1,304 (27.5%) received opioids while 1,101 (23.2%) only received either acetaminophen, NSAIDs, or both. Among those given opioids, 287 (22.0%) returned to the ED for abdominal pain within 30 days, compared to 162 (14.7%) of those in the reference group (OR 1.57 [1.27-1.95], p-value <0.001).


      Patients given opioids for abdominal pain in the ED had 57% increased odds of a return ED visit within 30 days compared to those given only acetaminophen and/or NSAIDs. This warrants further research on the use of nonopioid analgesics in the ED, especially in patients with anticipated discharge.
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