R. C. Baker1, B. C. Kenney1, J. S. Lee1, M. P. Klueh1, H. M. Hu1, M. J. Englesbe1, C. M. Brummett2, J. F. Waljee1 1University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 2University Of Michigan,Department Of Anesthesiology,Ann Arbor, MI, USA
Introduction: Although opioid analgesics are effective for acute pain, data suggest that prolonged use can occur following elective surgery. To date, the occurrence of new persistent use and the coordination of care for patients with emergency and trauma-related conditions is not well understood. Our objective was to describe the occurrence of new persistent opioid use and transitions of care for patients discharged with trauma-related conditions.
Methods: We examined a national sample of insurance claims for inpatients with a primary diagnosis of a trauma-related condition from 2004 to 2017 drawn from OptumInsight. We included patients ages 18-64 who did not fill an opioid prescription in the 12 months prior to their admission. Our primary outcome was the occurrence of new persistent opioid use, defined as 1 or more opioid refills in the 91-180 days following discharge. We used logistic regression to identify factors associated with new persistent use. The secondary outcomes included the change in prescriber specialties of opioids following trauma-related discharge among new persistent opioid use patients. Unadjusted rates of prescribing by specialty were compared across several post-discharge periods; 0-14 days to capture the initial discharge prescription, 15-90 days, and 91-180 days.
Results: In this cohort of 41,691 opioid naïve patients discharged with a trauma-related diagnosis, 12.7% (n=5,314) developed new persistent opioid use. Logistic regression produced the following associations to new persistent opioid use: female gender (OR, 1.31; CI, 1.07-1.20), increased Charlson Comorbidity Index (OR, 1.12; CI, 1.09-1.13), history of substance abuse (OR, 1.35; CI, 1.18-1.55), and history of mental health conditions (OR, 1.32; CI, 1.23-1.43). Among new persistent opioid use patients, the majority of prescriptions filled in the initial hospital discharge period were provided by surgeons, 45.6%, and 23.7% were provided by primary care physicians. For refills provided within 15-90 days following discharge, 52.2% were provided by surgeons and 25.4% were provided by primary care physicians. For fills provided between 91-180 days following discharge, 38.5% were provided by surgeons and 31.0% were provided by primary care physicians. All other provider groups increased prescribing by 2-4% between the 15-90 and 91-180 days following discharge.
Conclusion: Among opioid-naïve patients discharged with trauma-related diagnoses, 12.7% develop new persistent opioid use. Although the majority of initial fills and refills are provided by surgeons, subsequent fills are frequently provided by other specialties. Efforts to curb new persistent use should focus on these transitions of care to identify vulnerable patients early on in their recovery.
