M. A. Chaudhary1, N. K. Kwon1, N. Bhulani1, E. D. Jager1, T. P. Koehlmoos2, A. H. Haider1, A. J. Schoenfeld1 1Brigham And Women’s Hospital,Center For Surgery And Public Health,Boston, MA, USA 2Uniformed Services University Of The Health Sciences,Bethesda, MD, USA
Introduction:
Prior opioid use is known to be associated with adverse clinical outcomes in surgical and trauma patients. The impact of such use on post-discharge opioid patterns following trauma has not been evaluated. In this context, we sought to determine the association of prior opioid use on continued opioid dependence following major orthopedic trauma.
Methods:
We queried TRICARE insurance claims data (2006-2014) for records of adult (18-64 years) patients who sustained major orthopedic injuries defined using ICD-9 code. Patients that died during hospitalization were excluded. Prior opioid use was categorized as unexposed, exposed (any use within 6-month prior to trauma) and sustained use (6-month continuous use before trauma). Multivariable Cox Proportional Hazards models adjusting for socio-demographic and clinical factors, as well as the environment of care were utilized to determine association with opioid discontinuation following hospitalization. Missing demographic information was accounted for using re-weighted estimating equations.
Results:
We were able to include 11,752 patient records. Among these, 29.4% (n=3,456) had some prior opioid use while 5% (n=586) met criteria for sustained use. After discharge, 10.2% (n=1,194) continued opioid use beyond 6 months. In multivariable models prior opioid exposure [Hazards Ration (HR): 0.78, Confidence Interval (CI): 0.74-0.82] and sustained use at the time of injury [HR: 0.40, CI: 0.35-0.47] were associated with a lower likelihood of opioid discontinuation (Figure). Additionally, advanced age [(55-64 vs. 18-24) HR: 0.75, CI: 0.66-0.86], lower socio-economic status [(Enlisted vs. Officers) HR: 0.71, CI: 0.65-0.78], depression (HR: 0.81, CI: 0.72-0.91), anxiety (HR: 0.80, CI: 0.68-0.94), injury severity score (ISS) [(>25 vs. <9) HR: 0.68, CI: 0.60-0.76] and longer ICU length of stay (HR: 0.71, CI: 0.66-0.76) depression (HR: 0.81, CI: 0.72-0.91) and anxiety (HR: 0.80, CI: 0.68-0.94) were also associated with a lower likelihood of opioid discontinuation.
Conclusion:
Our results indicate that prior opioid use is strongly associated with continued dependence among major orthopedic trauma patients after discharge. Appropriate discharge planning, cautious prescription practices and engaging outpatient care service in patients with factors associated with sustained use may reduce the likelihood of this outcome post-discharge.
