Objective: The purpose of this study was to determine which factors influence inpatient and postdischarge opioid use after orthopaedic trauma. Design: Retrospective cohort study. Setting: Single Level 1 trauma center. Participants: The study included 235 adult trauma patients treated operatively for fracture with minimum 1 overnight hospital stay. Intervention: Operative fracture management. Main Outcome Measurement: Total opioid pain medication use, in oral morphine equivalents, in inpatient and postdischarge settings. Results: Controlling for length of stay, inpatient opioid use was negatively correlated with age and positively correlated with Injury Severity Score, intensive care unit (ICU) admission, and baseline tobacco use (P < 0.0001, adjusted R2 = 0.274). Discharge opioid prescription amount was negatively correlated with age, the presence of a complication, and ICU admission and positively correlated with inpatient opioid use (P < 0.0001, adjusted R2 = 0.201). Postdischarge opioid use was associated with larger amounts of opioids prescribed at discharge, a patient history of alcohol use at baseline, and ICU admission (P < 0.0001, R2 = 0.123). Conclusion: Nonmodifiable factors accounted for the level of inpatient opioid use in a trauma population. Higher inpatient use predicts larger opioid prescriptions at discharge, whereas larger discharge prescription predicts greater postdischarge opioid use. Strategies to reduce postdischarge opioid use should begin with reductions in inpatient opioid use. Multimodal pain strategies may be needed to achieve this goal. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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Introduction:The purpose of this study was to quantify how opioid use in patients with traumatic injury compared with opioid use in patients undergoing elective arthroplasty.Methods:In a retrospective review, 235 adult trauma patients treated surgically for fracture were compared with 98 patients undergoing elective total hip or knee arthroplasty. Inpatient, discharge, and postdischarge opioid use were recorded in oral morphine equivalents (OMEs).Results:There were no differences between trauma and elective arthroplasty patients for inpatient opioid use (OME/day: 70.2 vs. 67.3; P = 0.53), discharge prescription (OME: 542 vs. 594; P = 0.13), or postdischarge opioid use (OME: 986 vs. 1,147; P = 0.29). Postdischarge opioid use was positively correlated with Caucasian race, intensive care unit admission, baseline alcohol or opioid use, and higher discharge prescriptions (P < 0.0001; adjusted R2 = 0.127). Discharge prescription amount was the most significant predictor.Discussion:Traumatic injury is not a predictor of high post-discharge opioid use. Demographic, social, and physician prescribing behaviors contribute to higher postdischarge opioid consumption.