Opioid Prescription Associated With ED Return Visit in Hidradenitis Suppurativa

Many United States patients with hidradenitis suppurativa (HS) use the emergency department (ED) for treatment instead of a dermatology clinic. Those requiring additional treatment, particularly patients on Medicaid and patients who received an opioid prescription on the initial visit, are prone to return to the ED for treatment. These are among the study findings published in the Journal of the American Medical Association Dermatology.

Researchers sought to investigate which interventions and patient factors were associated with patient ED return after an initial ED visit for treatment of HS. The primary outcomes were dermatology outpatient follow-up or return to the ED for HS or related proxy within 30 days or within 180 days of initial ED visit.

Researchers conducted a retrospective cohort study using data from the Multi-State Medicaid and IBM MarketScan Commercial databases that included 20,269 adult patients with HS (82.9% women). This cohort (median 32 years of age, IQR 25-41 years) was established with patients with at least 2 claims for HS and at least 1 ED visit for HS or a defined proxy from January 2010 to July 2019. Exposures included components associated with ED visits and patient qualities. Data analysis occurred November 2021 to May 2022.

Researchers noted that 63.2% of these patients had Medicaid; 52.0% of whom were Black and 36.2% were White. In total, 36.8% had commercial insurance. At the initial ED visit, 48% of patients underwent incision and drainage (I&D), 72.6% received an oral antibiotic prescription, and 48.9% received an opioid medication prescription. Overall, patients were 18 to 34 years of age (60.5%), and had obesity (22.5%), and diabetes (11.9%).

Researchers observed that more than 17% of patients had a return visit to the ED for HS or proxy within 30 days vs 2.4% with a dermatology clinic visit (P <.001). In addition, 34% of patients had a return visit to the ED for HS or proxy within 180 days vs 6.8% with a dermatology clinic visit (P <.001). They noted patients who underwent initial I&D were associated with increased odds of ED follow-up within 30 days and within 180 days vs patients without I&D procedure. Having I&D was also associated with increased odds of a dermatology clinic follow-up.

They found that opioid medication prescription was associated with significantly increased odds of ED follow-up within 30 days (odds ratio [OR] 1.67; 95% CI, 1.54-1.80; P <.001) and within 180 days (OR 1.48; 95% CI, 1.39-1.58; P <.001) and significantly less likely to have a dermatology follow-up within 30 days (OR 0.78; 95% CI, 0.64-0.95; P =.01) or within 180 days (OR 0.81; 95% CI, 0.71-0.91; P <.001).  

Patients with Medicaid were more likely to return for HS treatment to the ED (OR 1.48; 95% CI, 1.38-1.58; P <.001) within 180 days and less likely to have a dermatology follow-up (OR 0.16; 95% CI, 0.14-0.18; P <.001).

Study limitations include small effect sizes for some of the observed associations (statistically significant but not clinically significant), lack of granularity using administrative data, under-coding and misclassification bias, patients lacking continuous insurance coverage dropped from analysis, and MarketScan Research Databases based on convenience sampling and results may not be generalizable.

Researchers concluded “patients with HS presenting to the ED for their disease exhibited high rates of ED return with low rates of dermatology follow-up after an initial ED visit.” Increased odds of ED return and decreased odds of dermatology follow-up were significantly associated with receiving an opioid prescription after the initial ED visit and Medicaid status, they summarized.

Disclosure: Several study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.