Understanding the Opioid Epidemic: Factors Predictive of Inpatient and Postdischarge Prescription Opioid Use After Orthopaedic Trauma

被引:37
作者
Flanagan, Christopher D. [1 ]
Wysong, Elena F. [1 ]
Ramey, James Scott [1 ]
Vallier, Heather A. [1 ]
机构
[1] Case Western Reserve Univ, MetroHlth Med Ctr, Dept Orthopaed Surg, Cleveland, OH 44106 USA
关键词
pain; opiate; opioid; trauma; injury; risk; NONSTEROIDAL ANTIINFLAMMATORY DRUGS; TOTAL KNEE ARTHROPLASTY; OPIATE USE; PAIN; ADDICTION; RECEPTORS; SURGERY; ABUSE;
D O I
10.1097/BOT.0000000000001256
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
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 R-2 = 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 R-2 = 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, R-2 = 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.
引用
收藏
页码:E408 / E414
页数:7
相关论文
共 41 条
[1]   Pain control after total knee arthroplasty: a randomized trial comparing local infiltration anesthesia and continuous femoral block [J].
Affas, Fatin ;
Nygards, Eva-Britt ;
Stiller, Carl-Olav ;
Wretenberg, Per ;
Olofsson, Christina .
ACTA ORTHOPAEDICA, 2011, 82 (04) :441-447
[2]  
American College of Surgeons, 2016, ANN M AM COLL SURG W
[3]   Influence of δ-Opioid Receptors in the Behavioral Effects of Nicotine [J].
Berrendero, Fernando ;
Plaza-Zabalala, Ainhoa ;
Galeote, Lola ;
Flores, Africa ;
Bura, S. Andreea ;
Kieffer, Brigitte L. ;
Maldonado, Rafael .
NEUROPSYCHOPHARMACOLOGY, 2012, 37 (10) :2332-2344
[4]  
Center for Behavioral Health Statistics and Quality, 2015, 2015 NAT SURV DRUG U
[5]   Characteristics of opiate users presenting for a new treatment episode: Baseline data from the national drug treatment outcome study in Ireland (ROSIE) [J].
Cox, Gemma ;
Comiskey, Catherine .
DRUGS-EDUCATION PREVENTION AND POLICY, 2007, 14 (03) :217-230
[6]   Effects of nonsteroidal anti-inflammatory drugs on bone formation and soft-tissue heating [J].
Dahners, LE ;
Mullis, BH .
JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS, 2004, 12 (03) :139-143
[7]   Toward a global view of alcohol, tobacco, cannabis, and cocaine use: Findings from the WHO World Mental Health Surveys [J].
Degenhardt, Louisa ;
Chiu, Wai-Tat ;
Sampson, Nancy ;
Kessler, Ronald C. ;
Anthony, James C. ;
Angermeyer, Matthias ;
Bruffaerts, Ronny ;
de Girolamo, Giovanni ;
Gureje, Oye ;
Huang, Yueqin ;
Karam, Aimee ;
Kostyuchenko, Stanislav ;
Lepine, Jean Pierre ;
Mora, Maria Elena Medina ;
Neumark, Yehuda ;
Ormel, J. Hans ;
Pinto-Meza, Alejandra ;
Posada-Villa, Jose ;
Stein, Dan J. ;
Takeshima, Tadashi ;
Wells, J. Elisabeth .
PLOS MEDICINE, 2008, 5 (07) :1053-1067
[8]   Risks for opioid abuse and dependence among recipients of chronic opioid therapy: Results from the TROUP Study [J].
Edlund, Mark J. ;
Martin, Bradley C. ;
Fan, Ming-Yu ;
Devries, Andrea ;
Braden, Jennifer B. ;
Sullivan, Mark D. .
DRUG AND ALCOHOL DEPENDENCE, 2010, 112 (1-2) :90-98
[9]   An Analysis of Heavy Utilizers of Opioids for Chronic Noncancer Pain in the TROUP Study [J].
Edlund, Mark J. ;
Martin, Bradley C. ;
Fan, Ming-Yu ;
Braden, Jennifer Brennan ;
Devries, Andrea ;
Sullivan, Mark D. .
JOURNAL OF PAIN AND SYMPTOM MANAGEMENT, 2010, 40 (02) :279-289
[10]   CONTINUOUS INTRAVENOUS ADMINISTRATION OF KETOROLAC REDUCES PAIN AND MORPHINE CONSUMPTION AFTER TOTAL HIP OR KNEE ARTHROPLASTY [J].
ETCHES, RC ;
WARRINER, CB ;
BADNER, N ;
BUCKLEY, DN ;
BEATTIE, WS ;
CHAN, VWS ;
PARSONS, D ;
GIRARD, M .
ANESTHESIA AND ANALGESIA, 1995, 81 (06) :1175-1180