Association of pre-admission opioid abuse and/or dependence on major complications in traumatic brain injury (TBI) patients

J Clin Anesth. 2022 Aug;79:110719. doi: 10.1016/j.jclinane.2022.110719. Epub 2022 Mar 8.

Abstract

Setting: In the last few decades, an opioid related health crisis has been a challenging problem in many countries around the world, especially the United States. Better understanding of the association of pre-admission opioid abuse and/or dependence (POAD) on specific major complications in traumatic brain injury (TBI) patients can aid the medical team in improving patient care management and outcomes.

Study objective: Our goal is to assess and quantify the risk of POAD on in-hospital mortality and major complications in TBI patients.

Design: We conducted a retrospective study and used the National Inpatient Sample (NIS) database from 2004 to 2015 to investigate the impact of POAD on in-hospital mortality and major complications in TBI patients. We utilized propensity score matching and conditional logistic regression models, adjusted with injury severity score (ISS) and comorbidities, to obtain the adjusted odds ratios (OR).

Main results: POAD TBI patients had lower risks of in-hospital mortality (OR 0.58; p < 0.001) and acute myocardial infarction (OR 0.53; p = 0.045), while a higher risk of respiratory (OR 1.59; p < 0.001) and neurologic complications (OR 2.54; p < 0.001), compared to non-POAD TBI patients. Additionally, POAD patients were significantly more likely to have sepsis (OR 2.16, p < 0.001), malnutrition (OR 1.56, p < 0.001), delirium (OR 2.81, p < 0.001), respiratory failure (OR 1.79, p < 0.001), and acute renal failure (OR 1.83, p < 0.001). POAD TBI patients had shorter length of hospital stay compared to non-POAD TBI patients (mean 8.0 vs 9.2 days, p < 0.001).

Conclusions: POAD TBI patients have a lower in-hospital mortality, shorter duration of hospitalization and a lower risk of acute myocardial infarction, while they are more likely to have respiratory failure, delirium, sepsis, malnutrition, and acute renal failure compared to TBI patients without POAD. Prospective study is warranted to further confirm these findings.

Keywords: Addiction; Dependence; National Inpatient Sample (NIS); Opioid abuse; Traumatic brain injury.

MeSH terms

  • Acute Kidney Injury*
  • Animals
  • Brain Injuries, Traumatic* / complications
  • Delirium*
  • Female
  • Horses
  • Hospital Mortality
  • Humans
  • Male
  • Malnutrition*
  • Myocardial Infarction*
  • Opioid-Related Disorders*
  • Prospective Studies
  • Respiratory Insufficiency* / epidemiology
  • Respiratory Insufficiency* / etiology
  • Retrospective Studies
  • Sepsis* / epidemiology
  • United States / epidemiology