Effect of injury location and severity on opioid use after trauma

Abstract

Recent data have suggested that persistent opioid use is prevalent following trauma. The effect of type of injury and total injury burden is not known. We sought to characterize the relationship between injury location and severity and risk of persistent opioid use. METHODS:We investigated postdischarge opioid utilization among patients who were admitted for trauma between January 2010 and June 2017 using the Optum Clinformatics Database. New persistent opioid use (NPOU) was defined as one of the following scenarios: (1) two separate opioid prescription fills between 0 and 14 days postdischarge and having 1+ fills in the 91 to 180 days following discharge or (2) filling a prescription in the 15 to 90 days following discharge in addition to a filling in the 91 to 180 day postdischarge period. Multivariable logistic regression was used to assess the relationship between injury type and severity with new persistent opioid use development. RESULTS:A total of 26,437 opioid-naive patients were included in the analysis. Overall, 2,277 patients (8.6%) met the criteria for NPOU.After adjustment for confounding, NPOU was significantly more common for patients with injury to the extremities (adjusted odds ratio [aOR], 1.75; 95% confidence interval [CI], 1.57-1.94) or abdomen (adjusted odds ratio [aOR], 1.42; 95% CI, 1.22-1.64). Importantly, patients with maximum Abbreviated Injury Scale score of ≥2 for any body region had 1.49-fold odds of NPOU compared with patients with score of 1 (95% CI, 1.28-1.73), while no difference was seen across groupings of total injury burden based on Injury Severity Score. CONCLUSION:New persistent opioid use is common among patients suffering from trauma. In addition, patients suffering from extremity and abdominal injuries are at highest risk. Maximum individual region injury severity predicts development of new persistent use, whereas total injury severity does not.

Long-term opioid use following bicycle trauma: a register-based cohort study

“…Only 8% of the trauma patients became long-term opioid users. Even though a lower number would be desirable, this percentage is comparable to the prevalence of prolonged opioid use in other studies [29][30][31]. Furthermore, some other studies reported an even higher prevalence of opioid use after musculoskeletal trauma at discharge from the hospital as well as in the longer term (54.3-97.1% and 19.7-35.3%, respectively) [32][33][34][35].…”

Persistent Long-Term Opioid Use After Trauma: Incidence and Risk Factors

“…Previous studies of persistent opioid use have used a variable duration of follow-up, ranging from 30 to 365 days after a defined event, with most selecting a 3-to 6-month interval. [10][11][12][25][26][27][28] The variability in defining persistent opioid use was highlighted in a 2020 analysis of the existing literature, where the authors found 29 distinct definitions across 39 different studies. 29 We selected and would advocate that a long length of follow-up should be used for trauma patients given the heterogeneity of this population.…”

“…The primary outcome of interest in this study was persistent long-term opioid use after trauma, which we defined as evidence of continued opioid use at 1 year following discharge. Previous studies of persistent opioid use have used a variable duration of follow-up, ranging from 30 to 365 days after a defined event, with most selecting a 3- to 6-month interval 10–12,25–28 . The variability in defining persistent opioid use was highlighted in a 2020 analysis of the existing literature, where the authors found 29 distinct definitions across 39 different studies 29 .…”

“…Other studies have demonstrated a high rate of prescription narcotic use at hospital discharge or for short intervals but do not offer long-term follow-up 9,10 . Insurance claims that databases have also been used to examine the issue, but these lack injury detail and offer data that may not be generalizable to other populations such as the uninsured 9–12 . Studies involving comprehensive national health systems in other countries provide additional data but obviously may not be translatable to the US trauma population 13 …”

“…9,10 Insurance claims that databases have also been used to examine the issue, but these lack injury detail and offer data that may not be generalizable to other populations such as the uninsured. [9][10][11][12] Studies involving comprehensive national health systems in other countries provide additional data but obviously may not be translatable to the US trauma population. 13 The purpose of this study was to examine the prevalence of prescription opioid use among trauma patients before and after injury.…”