The contribution of opiate analgesics to the development of infectious complications in trauma patients

Abstract

Trauma-related pain is a natural consequence of injury and its surgical management; however, the relationship between opiates and complications in trauma patients is unknown. To study this a retrospective chart review of selected subjects following traumatic injury with admission to the SICU for > 3 days was performed, and opiate administration data was collected for the first 3 days of admission. Associated data from each subject's chart was also collected. Analysis of the data revealed that increased opiate intake after admission to the SICU was associated with significantly increased SICU and hospital LOS independent of injury severity. This increase in LOS was independent of mechanical ventilation in the moderate ISS group. Infectious complications were also more prevalent in the moderate ISS group with higher opiate use. These findings suggest that increased doses of opiate analgesics in trauma patients may contribute to an increased overall LOS and associated infectious complications. Analgesic regimes that minimize opiate intake, while still providing adequate pain relief, may be advantageous in reducing LOS, complications and reduce hospitalization costs.

Keywords: ICU; LOS; Pain; analgesia; infection; mechanical ventilation.

Figure 1

CONSORT diagram of subject enrollment.

Figure 2

ICU length of stay (LOS) and opiate use. A. ICU LOS correlation with day 1 opiate intake after adjustment for ISS (P < 0.001); B. ICU LOS correlation with 3 day opiate intake after adjustment for ISS (P < 0.001). Both length of stay and opiate intake are in log units base 10. 1 was added to opiate intake prior to log transformation as described in the Materials and Methods.

Figure 3

Hospital length of stay (LOS) and opiate use. A. LOS correlation with day 1 opiate intake after adjustment for ISS (P = 0.0002); B. LOS correlation with 3 day opiate intake after adjustment for ISS (P < 0.001). Both length of stay and opiate intake are in log units base 10. 1 was added to opiate intake prior to log transformation as described in the Materials and Methods.

Figure 4

Relationship between LOS, opiate use and injury severity. Subjects were stratified based on injury severity (ISS) and LOS and opiate use (low and high) compared. A. ICU LOS; B. Hospital LOS. Data are expressed as median with the 25 and 75 percentiles in original units and P-values are based on a linear model of the log transformed LOS. The numbers in the parenthesis represent the number of subjects per group. *P < 0.05 as compared with respective low 3 day opiate group.

Figure 5

Infections in mechanically ventilated and non-mechanically ventilated patients. Infections were evaluated in 179 trauma patients with regard to mechanical ventilation (MV) and infection type [pneumonia, blood related infections, urinary tract (UTI), wound or other].

Figure 6

Infection rates in mechanically ventilated and non-mechanically ventilated patients. Infection rates were evaluated in 179 trauma patients with regard to mechanical ventilation (MV) ISS score (ISS < 10, ISS > 10, but < 24 and ISS > 24) and opiate use [low opiate equivalents (OE), and high OE] as described in the Materials and Methods. The odds ratios comparing the low OE and high OE groups are shown.

Figure 7

Impact of opiate intake on LOS in the intermediate ISS group. ICU and hospital LOS were compared in the intermediate ISS group (ISS > 10, but < 24) with regard to OE intake during the first 3 days after admission. Data are expressed as median with the 25 and 75 percentiles. *P < 0.001 as compared with the respective Low OE group.

Figure 8

Relationship between infection rates, ISS score and opiate use. Infection rates were evaluated in 179 trauma patients with regard to OE intake during the first 3 days after admission and ISS score (ISS < 10, ISS > 10, but < 24 and ISS > 24) as described in the Materials and Methods. The odds ratios comparing the low OE and high OE groups are shown.