Cannabis Use and Risk for 30-day hospital readmission among Inflammatory Bowel Disease Patients: Miriam
1 Blumenthal ,
1 MD ,
Ellen Oseni, Stephanie 1 and Keith Sultan, MD
1Donald
Conclusions
Results
Inflammatory Bowel Disease (IBD), composed mainly of Crohn’s disease and ulcerative colitis, is a disorder of chronic bowel inflammation. Classic manifestations of the disease include abdominal pain, diarrhea, rectal bleeding, weight loss, as well as extra intestinal symptoms, that may result in hospitalization. Current therapeutic interventions such as aminosalicylic acid, corticosteroids, and biologic agents are meant to treat the underlying intestinal inflammation(1). Opioids are commonly used to manage pain in IBD patients, despite evidence that they do not have a great impact on improving pain or quality of life (2). Opiate use for IBD has also been noted to be associated with higher rates of 30 day hospital readmission (3). Recently, there has been an increased interest regarding the use of cannabis in the management of IBD symptoms and flares, as a palliative alternative to opiates. Some studies indicate that nearly 20% of patients with IBD already use cannabis specifically for symptom management (4). The goal of this study was to examine the impact of cannabis use on 30-day hospital readmission in patients with IBD.
We identified 1028 patients hospitalized with IBD, 53.1% female, mean age 45 years old, 47.7% of whom had Crohn’s disease and 52.3% had ulcerative colitis. In total, 74 patients (7.2%) were cannabis users, breakdown of management in Figure 1. Of those who used cannabis, 70% were male. Readmission rates were similar among cannabis users and nonusers (Figure 2)
Hypothesis
Figure 1: Classification of cannabis use. This data was collected based on the specifications in the patients’ charts regarding whether they used cannabis recreationally or medicinally, and whether medicinal use was supervised by a physician.
Cannabis Use Classifications 7, 9%
➢ Patient identification by bioinformatics ➢ All IBD inpatients based on ICD-10 code ➢ Patients with active IBD based on medication (solumedrol, hydrocortisone, and infliximab) ➢ Data point collection (bioinformatics and manual chart review) ➢ Demographics ➢ Cannabis use and classification* ➢ Readmission within 30 days of discharge *manual chart review
➢ Cannabis use is common among patients hospitalized for IBD exacerbations ➢ While more females are hospitalized for IBD exacerbations than males, more male patients were found to use cannabis ➢ Most cannabis use is not medically supervised ➢ Cannabis does not appear to be associated with higher rates of 30 day hospital readmission
4, 5% 3, 4%
Future Direction
13, 18% 47, 64%
Active - Recreational Active- Medically Supervised Active - Medically Unsupervised Active - Unknown Past
➢ Analysis of subgroups for whom cannabis use may have a different impact (e.g. by disease type, medically supervised, etc) ➢ Need for more large prospective studies, especially those with better quantitative assessment of disease status ➢ Need for more accurate method of documenting cannabis use and frequency
Resources
30- Day Hospital Readmission 100%
Methods
Michael Qiu,
1 MD
and Barbara Zucker School of Medicine at Hofstra/Northwell
Background
We hypothesize that patients hospitalized with IBD flares who use cannabis to help manage their symptoms will not have increased 30 day readmission rates.
1 Izard ,
1.
95% 90%
2.
85% 80% 75%
3.
70% 65% 60% Non-users
Not Readmitted
Cannabis users
Readmitted
Figure 2: Percentage of patients re-admitted to the hospital within 30 days of initial discharge based on their cannabis use status.
4.
Kienzl, M., Storr, et al. Cannabinoids and Opioids in the Treatment of Inflammatory Bowel Diseases. Clinical and translational gastroenterology, 11(1), e00120. Sultan K, Swaminath A. From Bad to Worse: The Relationship Between Opioid Use and Inflammatory Bowel Disease. J Crohns Colitis. 2020 Sep 16;14(9):1188-1189. https://doi.org/10.14309/ctg.0000000000000120 Paris Charilaou, et al. Opioid Use Disorder Increases 30-Day Readmission Risk in Inflammatory Bowel Disease Hospitalizations: a Nationwide Matched Analysis, Journal of Crohn's and Colitis. 2020 May; 14 (5);636– 645, https://doi.org/10.1093/ecco-jcc/jjz198 Kerlin AM, et al. Profiles of Patients Who Use Marijuana for Inflammatory Bowel Disease. Dig Dis Sci. 2018 Jun;63(6):16001604. Epub 2018 Mar 29. PMID: 29594968.