Effect of injury location and severity on opioid use after trauma

Rachel C Baker; Craig S Brown; John R Montgomery; Charles A Mouch; Brooke C Kenney; Michael J Englesbe; Jennifer F Waljee; Mark R Hemmila

doi:10.1097/TA.0000000000003138

Effect of injury location and severity on opioid use after trauma

J Trauma Acute Care Surg. 2021 Jul 1;91(1):226-233. doi: 10.1097/TA.0000000000003138.

Authors

Rachel C Baker¹, Craig S Brown, John R Montgomery, Charles A Mouch, Brooke C Kenney, Michael J Englesbe, Jennifer F Waljee, Mark R Hemmila

Affiliation

¹ From the Department of Surgery (R.C.B., C.S.B., J.R.M., C.A.M., M.J.E., J.F.W., M.R.H.), University of Michigan; Michigan Opioid Prescribing Engagement Network (R.C.B., C.S.B., J.R.M., C.A.M., B.C.K., M.J.E., J.F.W.); and Center for Healthcare Outcomes and Policy (C.S.B., J.R.M., C.A.M., B.C.K., M.J.E., J.F.W., M.R.H.), University of Michigan, Ann Arbor, Michigan.

Abstract

Objective: Recent data have suggested that persistent opioid use is prevalent following trauma. The effect of type of injury and total injury burden is not known. We sought to characterize the relationship between injury location and severity and risk of persistent opioid use.

Methods: We investigated postdischarge opioid utilization among patients who were admitted for trauma between January 2010 and June 2017 using the Optum Clinformatics Database. New persistent opioid use (NPOU) was defined as one of the following scenarios: (1) two separate opioid prescription fills between 0 and 14 days postdischarge and having 1+ fills in the 91 to 180 days following discharge or (2) filling a prescription in the 15 to 90 days following discharge in addition to a filling in the 91 to 180 day postdischarge period. Multivariable logistic regression was used to assess the relationship between injury type and severity with new persistent opioid use development.

Results: A total of 26,437 opioid-naive patients were included in the analysis. Overall, 2,277 patients (8.6%) met the criteria for NPOU. After adjustment for confounding, NPOU was significantly more common for patients with injury to the extremities (adjusted odds ratio [aOR], 1.75; 95% confidence interval [CI], 1.57-1.94) or abdomen (adjusted odds ratio [aOR], 1.42; 95% CI, 1.22-1.64). Importantly, patients with maximum Abbreviated Injury Scale score of ≥2 for any body region had 1.49-fold odds of NPOU compared with patients with score of 1 (95% CI, 1.28-1.73), while no difference was seen across groupings of total injury burden based on Injury Severity Score.

Conclusion: New persistent opioid use is common among patients suffering from trauma. In addition, patients suffering from extremity and abdominal injuries are at highest risk. Maximum individual region injury severity predicts development of new persistent use, whereas total injury severity does not.

Level of evidence: Prognostic and epidemiological, level III.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Abbreviated Injury Scale
Abdominal Pain / drug therapy*
Adult
Analgesics, Opioid / therapeutic use*
Databases, Factual
Female
Humans
Injury Severity Score
Logistic Models
Male
Middle Aged
Multivariate Analysis
Opioid-Related Disorders / epidemiology*
Pain, Postoperative / drug therapy*
Patient Discharge
Risk Factors
United States / epidemiology
Wounds and Injuries / complications
Wounds and Injuries / therapy*

Substances

Analgesics, Opioid

Abstract

Publication types

MeSH terms

Substances

Grants and funding