• Tak Kyu Oh, In-Ae Song, Jae Ho Lee, Cheong Lim, Young-Tae Jeon, Hee-Joon Bae, You Hwan Jo, and Hee-Jung Jee.
• Department of Anesthesiology and Pain Medicine, South Korea. Electronic address: airohtak@hotmail.com.
• Br J Anaesth. 2019 Jun 1; 122 (6): e189-e197.

BackgroundThe aim of this study was to investigate the association of chronic opioid usage with 90-day mortality in critically ill patients after admission to the ICU.MethodsThis retrospective cohort study analysed the medical records of adult patients admitted to ICUs in a tertiary academic hospital between January 2012 and December 2017. Patients taking opioids regularly for more than 4 weeks before ICU admission were defined as chronic opioid users, whereas the others were defined as opioid-naïve patients.ResultsWe selected 18 409 patients for this study, including 757 (4.1%) chronic opioid users. After propensity matching, 2990 patients (chronic opioid users, 757; opioid-naïve, patient: 2233) were included in the analysis. The odds of 90-day mortality were higher in chronic opioid users than in opioid-naïve patients using both the generalised estimating equation model for the propensity-matched cohort (odds ratio=1.90; 95% confidence interval, 1.57-2.31; P<0.001) and the multivariable logistic regression model for the entire cohort (odds ratio=2.20; 95% confidence interval, 1.81-2.66; P<0.001). Additionally, this association was significant in cancer patients and non-chronic kidney disease (CKD) patients and was not significant in non-cancer and CKD patients.ConclusionsOur results suggest that in a cohort of critically ill adult patients, chronic opioid use is associated with an increase in 90-day mortality. This association was more evident in cancer patients and non-CKD patients.Copyright © 2019 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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