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. 2025 Apr 17;145(1):248.
doi: 10.1007/s00402-025-05864-2.

Prevalence and risk of chronic opioid use in orthopaedic polytrauma patients

Michael E Held  1 , Alex G Otwell  2 , Steven M Cherney  1 , Jeffery B Stambough  3 , Stephen M Bowman  2 , Simon C Mears  4
Affiliations

Prevalence and risk of chronic opioid use in orthopaedic polytrauma patients

Michael E Held et al. Arch Orthop Trauma Surg. .

Abstract

Introduction: Prolonged opioid usage has numerous side effects, contributing to poorer long-term outcomes. An unexplored area pertains to patient-specific factors that influence chronic opioid consumption in cases of multiple fractures. We aimed to assess the prevalence and identify risk factors for chronic opioid usage in orthopedic polytrauma patients.

Materials and methods: We retrospectively identified 167 patients who sustained multiple lower extremity fractures occurring at a level-one trauma between July 2017 and June 2020. Utilizing the state prescription monitoring database, we gathered opioid prescription data for 3 months before and one year following the surgical procedure.

Results: In total, 68 patients (41%) exhibited chronic opioid use after trauma. Of the 167 patients, 38 (22.7%) engaged in pre-admission opioid usage, of which 28 patients (73.7%) displayed chronic usage after discharge. Pre-admission opioid use (odds ratio 9.02, P = < 0.001) and an Injury Severity Score (ISS) greater than 15 (odds ratio 3.62, P = 0.007) increased the odds of chronic usage compared to those without these risk factors. The chronic use group had significantly more surgeries performed on average (mean 4 vs. 2.9; P = 0.015) and a higher frequency of open fractures (P = 0.017). Polytrauma patients that obtained greater amounts of Morphine Milligram Equivalents (MMEs) before, during, and after admission, were statistically more likely to become chronic opioid users.

Conclusions: Chronic opioid use is common after polytrauma. Polytrauma patients with pre-admission opioid use, a higher ISS, and escalated opioid requirements during hospitalization should be closely monitored for long-term opioid use. Sustained endeavors to mitigate opioid consumption and enhance non-opioid approaches are essential in preventing long-term challenges secondary to chronic opioid usage in polytrauma patients.

Level of evidence: Prognostic Level 2 Retrospective Cohort.

Keywords: Chronic pain; Fracture; Opioid use; Polytrauma.

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