Prior Prescription Opioid Use and Its Influence on Opioid Requirements After Orthopedic Trauma

被引:27
作者
Chaudhary, Muhammad Ali [1 ]
von Keudell, Arvind [2 ]
Bhulani, Nizar [1 ]
de Jager, Elzerie C. [1 ]
Kwon, Nicollette K. [1 ]
Koehlmoos, Tracey [3 ]
Haider, Adil H. [1 ]
Schoenfeld, Andrew J. [4 ]
机构
[1] Harvard Med Sch, Brigham & Womens Hosp, Dept Surg, Ctr Surg & Publ Hlth, Boston, MA 02115 USA
[2] Harvard Med Sch, Brigham & Womens Hosp, Dept Orthopaed Surg, Boston, MA 02115 USA
[3] Uniformed Serv Univ Hlth Sci, Bethesda, MD 20814 USA
[4] Harvard Med Sch, Brigham & Womens Hosp, Dept Orthopaed Surg, Ctr Surg & Publ Hlth, 75 Francis St, Boston, MA 02115 USA
关键词
RISK-FACTORS; POPULATION; PATTERNS; OUTCOMES; SURGERY; INJURY;
D O I
10.1016/j.jss.2019.01.016
中图分类号
R61 [外科手术学];
学科分类号
摘要
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. (C) 2019 Elsevier Inc. All rights reserved.
引用
收藏
页码:29 / 34
页数:6
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