2024 Scholars' Research Symposium Abstract: Immunosuppressive Opioids are Associated with Longer Hospital Length of Stay in SARS-CoV-2 Patients.

Abstract

Introduction: Since late 2019, SARS-CoV-2 has infected over 767 million people worldwide with over one million deaths in the United States alone. One risk factor identified for possible worse outcomes from the virus is medication-induced immune suppression. Some opioids have been associated with immunomodulatory effects. One immunomodulatory effect that has been linked to the use of these medications is reduced lymphocyte proliferation and macrophage dysfunction. Immune dysfunction has been associated with increased length of stay (LOS) in SARS-CoV-2 hospitalized patients. In the early years of the pandemic, hospitals quickly became overwhelmed by the number of patients needing hospitalization for treatment of the virus. Identifying risk factors and decreasing patient length of stay can ease the burden on staff and equipment needs. It was hypothesized that previous or current use of an immunosuppressive opioid is associated with longer hospital LOS for patients with SARS-CoV-2.

Methods: A retrospective chart review with 732 patients included in the final analysis was performed. Patient charts were collected from a regional Midwestern health system for hospitalized SARS-CoV-2 patients between July 1, 2020 through December 31, 2020. LOS stay was categorized as long (5 or more days) or short (less than 5 days). Patient demographics/ comorbid conditions were gathered and statistical analysis was performed using Microsoft Excel.

Results: Patients who have previously used morphine or fentanyl at any point in the prior year are associated with longer LOS (p less than 0.02). Starting morphine or fentanyl in-hospital was associated with longer LOS compared to those who have previously used (p less than 0.001 morphine, p less than 0.001 fentanyl). There was no significant difference between starting fentanyl or morphine in the hospital (p = 0.55).

Conclusions: The use of immunosuppressive opioids are associated with longer LOS in patients hospitalized for SARS-CoV-2. Starting an opioid in-hospital is associated with longer LOS than pre-hospital opioid use. No difference in hospital length of stay was found between patients treated with fentanyl or morphine. While it is possible that sicker patients may require more opioids, healthcare providers should consider avoiding the use of opioids with immunomodulatory effects and consider alternative drugs in patients hospitalized with SARS-CoV-2.