Understanding the Opioid Epidemic: Factors Predictive of Inpatient and Postdischarge Prescription Opioid Use After Orthopaedic Trauma

Abstract

Objective: The purpose of this study was to determine which factors influence inpatient and postdischarge opioid use after orthopaedic trauma.

Design: Retrospective cohort study.

Setting: Single Level 1 trauma center.

Participants: The study included 235 adult trauma patients treated operatively for fracture with minimum 1 overnight hospital stay.

Intervention: Operative fracture management.

Main outcome measurement: Total opioid pain medication use, in oral morphine equivalents, in inpatient and postdischarge settings.

Results: Controlling for length of stay, inpatient opioid use was negatively correlated with age and positively correlated with Injury Severity Score, intensive care unit (ICU) admission, and baseline tobacco use (P < 0.0001, adjusted R = 0.274). Discharge opioid prescription amount was negatively correlated with age, the presence of a complication, and ICU admission and positively correlated with inpatient opioid use (P < 0.0001, adjusted R = 0.201). Postdischarge opioid use was associated with larger amounts of opioids prescribed at discharge, a patient history of alcohol use at baseline, and ICU admission (P < 0.0001, R = 0.123).

Conclusion: Nonmodifiable factors accounted for the level of inpatient opioid use in a trauma population. Higher inpatient use predicts larger opioid prescriptions at discharge, whereas larger discharge prescription predicts greater postdischarge opioid use. Strategies to reduce postdischarge opioid use should begin with reductions in inpatient opioid use. Multimodal pain strategies may be needed to achieve this goal.

Level of evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.