{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T15:39:41Z","timestamp":1793720381133,"version":"4.6.1"},"reference-count":17,"publisher":"SAGE Publications","issue":"10","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Intensive Care Med"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Opioid stewardship is central to postoperative critical care, yet the prognostic value of short-term opioid dose escalation in the intensive care unit (ICU) remains unclear. In non-ICU settings, escalating opioid requirements have been associated with poorly controlled pain, postoperative complications, and increased readmission rates. Whether similar relationships exist in critically ill postoperative patients has not been established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine whether early postoperative opioid escalation during the first 72\u2005hours after major surgery is associated with 90-day hospital readmission among ICU patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study used the publicly available Medical Information Mart for Intensive Care IV (MIMIC-IV, version 3.1) database (2008-2022). Adults aged \u2265 18 years admitted to the ICU after major orthopedic, general, or neurosurgical procedures were included. Opioid escalation was defined as total morphine milligram equivalents (MME) administered during hours 48-71 exceeding twice the MME during hours 0-23 after ICU admission. The primary outcome was all-cause hospital readmission within 90 days of discharge. Multivariable logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs), controlling for age, sex, Charlson Comorbidity Index (CCI), and surgical category.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 613 patients analyzed, mean (SD) age was 65 (15) years and 342 (55.8%) were male. Opioid escalation occurred in 126 patients (20.6%), and readmission in 229 (37.4%). In multivariable logistic regression adjusted for age, sex, Charlson Comorbidity Index, and surgical category, escalation was not associated with readmission (adjusted odds ratio, 1.05; 95% CI, 0.68 to 1.63; P\u2009=\u2009.83).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In critically ill postoperative patients, short-term opioid escalation was not associated with 90-day readmission. These null findings suggest escalation may be a poor-quality metric in the intensive care unit due to high baseline opioid exposure and continuous monitoring. Further evaluation in non-intensive care unit settings is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08850666261425613","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T16:57:42Z","timestamp":1772038662000},"page":"1008-1012","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Opioid Escalation in the ICU and 90-Day Readmission After Major Surgery: A Retrospective Cohort Study Using the MIMIC-IV Database"],"prefix":"10.1177","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8032-611X","authenticated-orcid":false,"given":"Angel G.","family":"A. Prempeh","sequence":"first","affiliation":[{"name":"Michigan State University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"Tenfelde","sequence":"additional","affiliation":[{"name":"Michigan State University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.1464"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0898"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0504"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002458"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.3109\/15360288.2012.751956"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1H386"},{"issue":"2","key":"e_1_3_3_8_2","first-page":"137","article-title":"Underlying reasons associated with hospital readmission following surgery in the United States","volume":"150","author":"Merkow RP","year":"2015","unstructured":"Merkow RP, Ju MH, Chung JW, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA Surg. 2015;150(2):137\u2013145.","journal-title":"JAMA Surg"},{"key":"e_1_3_3_9_2","first-page":"510","volume-title":"Pain assessment and pharmacologic management","author":"Pasero C","year":"2011","unstructured":"Pasero C, McCaffery M. Pasero Opioid-Induced Sedation Scale (POSS). In: Pain assessment and pharmacologic management. St. Louis, MO: Mosby\/Elsevier; 2011:510."},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.H.00286"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000003299"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-022-01899-x"},{"key":"e_1_3_3_13_2","unstructured":"Centers for Disease Control and Prevention. CDC opioid data analysis and resources. https:\/\/www.cdc.gov\/opioids\/data-analysis-resources\/index.html."},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_3_3_15_2","unstructured":"Google Cloud. BigQuery ML documentation. https:\/\/cloud.google.com\/bigquery-ml\/docs."},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.2137"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000218416.62457.56"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare9030333"}],"container-title":["Journal of Intensive Care Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08850666261425613","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/08850666261425613","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/08850666261425613","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T17:52:48Z","timestamp":1788544368000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/08850666261425613"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,25]]},"references-count":17,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1177\/08850666261425613"],"URL":"https:\/\/doi.org\/10.1177\/08850666261425613","relation":{},"ISSN":["0885-0666","1525-1489"],"issn-type":[{"value":"0885-0666","type":"print"},{"value":"1525-1489","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,25]]}}}