W. C. Kethman1, L. Sceats1, L. Tennakoon1, K. L. Staudenmayer1 1Stanford University,Division Of Trauma And Critical Care,Palo Alto, CA, USA
Introduction: The CDC reported that 11.5M non-institutionalized adults misused opioids in 2015. Exposure to opioids through legal prescriptions is thought to contribute to this opioid crisis. Another exposure to prescribed opioids may occur during inpatient hospitalization, and inpatients may be at risk for an extreme version of this exposure, opioid poisoning. Despite our current understanding of the opioid epidemic, limited data exists on the occurrences of opioid misuse in vulnerable populations such as the hospitalized trauma patient.
Methods: This is a retrospective multi-institutional cohort study utilizing data from the 2008-2014 Nationwide Inpatients Sample, Healthcare cost and utilization Project, and Agency for Healthcare Research and Quality database. Patients were included in the study if they were 18 years or older and had a primary ICD-9 diagnosis of trauma and any diagnosis of opioid poisoning. Trauma characteristics were further evaluated using the ICDPIC module. Costs were determined using cost-to-charge ratio files. Unadjusted and adjusted analyses were performed and all reported values represent weighted estimates.
Results: Overall, 9,314,780 trauma patients were included in this analysis, of which, 2,970 (0.03%) suffered from opioid poisoning. The rates of opioid poisonings during these years have remained unchanged over the study period (p=0.21). In multiple logistic regression analysis, ISS >15 (OR 0.58, 95% CI 0.43-0.79, p=0.001), increasing age (OR 0.98, 95% CI 0.98-0.99, p<0.001), and isolated extremity injuries (OR 0.6, 95% CI 0.46-0.79, p<0.001) were associated with lower odds ratio of opioid poisoning. In contrast, female gender (OR 1.5, 95% CI 1.3-1.9, p<0.001) was associated with higher risk. Injury characteristics of patients suffering from opioid poisoning are demonstrated in Figure 1. Trauma patients who suffer from opioid poisonings are hospitalized longer (Mean=6.6, SD=6.6 vs. Mean=5.2, SD=6.8 p<0.001) and have more costly hospitalizations (Mean=$19,202, SD=$22,687 vs. Mean=$16,248, SD=$22,572 p<0.001).
Conclusion: Despite focused efforts to raise awareness and reduce opioid misuse, inpatient opioid poisonings occurred in approximately 3,000 trauma patients over the study period. These risks are higher in female patients, those with minor injuries, and those with non-extremity injuries, which is a group likely at risk of discharge with opioids. This suggests that a pattern of opioid misuse may begin with a patient’s initial inpatient hospitalization for trauma. Opioid stewardship for trauma patients is more than just an outpatient responsibility, and likely begins during the initial inpatient hospitalization.
