Prior prescription opioid use and Its influence on opioid requirements after orthopedic trauma

Authors

Muhammad Ali Chaudhary, Harvard Medical School, Boston, Massachusetts
Arvind von Keudell, Harvard Medical School, Boston, Massachusetts
Nizar Bhulani, Harvard Medical School, Boston, Massachusetts
Elzerie C. de Jager, Harvard Medical School, Boston, Massachusetts
Nicollette K. Kwon, Harvard Medical School, Boston, Massachusetts
Tracey Koehlmoos, University of the Health Sciences, Bethesda, Maryland
Adil H. Haider, Harvard Medical School, Boston, MassachusettsFollow
Andrew J. Schoenfeld, Harvard Medical School, Boston, Massachusetts

Document Type

Article

Department

General Surgery

Abstract

Background: Prior opioid use has been shown to be associated with adverse outcomes in surgical and trauma patients. We sought to evaluate the influence of prior opioid use on prescription opioid requirements after orthopedic trauma.
Materials and methods: This was a retrospective review of TRICARE claims (2006-2014). We evaluated the records of 11,752 patients treated for orthopedic injuries. Surveillance for prior opioid exposure extended to 6 mo before the traumatic event, with similar postinjury surveillance. Preinjury opioid use was categorized as unexposed, exposed without sustained use (nonsustained users), and sustained use (6 mo or longer of continuous opioid prescriptions without interruption). Multivariable Cox proportional hazard models were used to adjust for confounding and determine factors independently associated with the discontinuation of prescription opioid use after traumatic injury.
Results: Prior opioid exposure among nonsustained users (hazard ratio 0.78; 95% CI 0.74, 0.83) and sustained use at the time of injury (hazard ratio 0.40; 95% CI: 0.35, 0.47) were associated with lower likelihoods of opioid discontinuation. Additional factors associated with lower likelihoods of opioid discontinuation included our proxy for lower socioeconomic status, history of depression or anxiety, injury severity, and intensive care unit admission.
Conclusions: Prior opioid use is one of the strongest predictors of continued use following treatment, along with socioeconomic status, behavioral health disorders, and severity of injury. Appropriate discharge planning and early engagement of ancillary services in individuals with one or more of the risk factors identified here may reduce the likelihood of sustained opioid use after injury.

Comments

Issue no are not provided by the author/publisher

Publication (Name of Journal)

The Journal of surgical research

Recommended Citation

Chaudhary, M. A., Keudell, A. v., Bhulani, N., de Jager, E. C., Kwon, N. K., Koehlmoos, T., Haider, A. H., Schoenfeld, A. J. (2019). Prior prescription opioid use and Its influence on opioid requirements after orthopedic trauma. The Journal of surgical research, 238, 29-34.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/236