(671) Factors Affecting Acute and Prolonged Opioid Utilization in Aneurysmal Subarachnoid Hemorrhage

Introduction: Headaches secondary to an aneurysmal subarachnoid hemorrhage (aSAH) occur in a considerable proportion of patients and can persist for years with associated reduced quality of life. They are often difficult to manage and require numerous pharmacologic agents to control. The purpose of this study is to assess patient factors associated with higher acute and chronic opioid utilization.

Methods: This was a retrospective cohort study of adult patients admitted to Methodist University Hospital (MUH) with aSAH from January 1, 2018, to December 31, 2022. The primary objective was to determine patient factors associated with higher total opioid equivalents consumed in the first week of hospitalization. High opioid dose was defined by requiring more than 30 morphine milligram equivalents per day. Secondary objectives were to assess opioid utilization at six months and one year. The effect of gabapentin dose on opioid utilization during hospitalization was assessed.

Results: A total of 400 patients were screened, with 72 included in the final analysis. High-dose opioids were required in 23 patients (32%). Patients who required high-dose opioids were younger (41 ± 10 v. 51 ± 13; p < .001), had higher BMI (34 ± 9 v. 30 ± 8; p = 0.05), reported alcohol use (8 (35%) v. 4 (8%); p = 0.014), higher incidence of vasospasms (10 (43%) v. 6 (12%); p = 0.005), and had reported use of morphine (18 (78%) v. 25 (51%); p = 0.039), oxycodone (22 (96%) v. 31 (63%); p = 0.004), and steroids (21 (91%) v. 27 (55%); p = 0.003). Patients in the high-dose opioid group were more likely to discharge with an opioid prescription ( 20 (87%) v. 31 (63%), p = 0.052). At 6 months and 1 year follow-up, there were 3 patients (15%) who had an opioid prescription. There were 29 patients (40%) who received gabapentin; however, its use did not have a significant effect on opioid utilization.

Conclusions: Patients who required higher opioid doses were younger, or obese, had reported alcohol use, vasospasms, or also received morphine, oxycodone, or steroids. High-dose opioid usage during hospitalization did not lead to prolonged opioid utilization.