A systematic review of opioid use after extremity trauma in orthopedic surgery

Koehler, Rikki M.; Okoroafor, Ugochi C.; Cannada, Lisa K.

doi:10.1016/j.injury.2018.04.003

Cited by 60 publications

(52 citation statements)

References 30 publications

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“…Previous studies have shown similar findings in both orthopaedic 32 and trauma 33 populations. Severe injury to several different AIS regions was associated with chronic opioid use, with the strongest association for the legs, indicating the importance of orthopaedic injury, in line with previous findings 34 . Furthermore, ICU admission commonly involving opioid-based pain treatment was associated with chronic opioid use.…”

Section: Discussionsupporting

confidence: 90%

Risk factors and outcomes of chronic opioid use following trauma

Oelreich

Eriksson

Brattström

et al. 2020

British Journal of Surgery

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Background The growing problem of opioid misuse has become a serious crisis in many countries. The role of trauma as a gateway to opioid use is currently not determined. The study was undertaken to assess whether traumatic injury might be associated with chronic opioid use and accompanying increased long‐term mortality. Methods Injured patients and controls from Sweden were matched for age, sex and municipality. After linkage to Swedish health registers, opioid consumption was assessed before and after trauma. Among injured patients, logistic regression was used to investigate factors associated with chronic opioid use, assessed by at least one written and dispensed prescription in the second quarter after trauma. Cox regression was employed to study excess risk of mortality. In addition, causes of death for postinjury opioid users were explored. Results Some 13 309 injured patients and 70 621 controls were analysed. Exposure to trauma was independently associated with chronic opioid use (odds ratio 3·28, 95 per cent c.i. 3·02 to 3·55); this use was associated with age, low level of education, somatic co‐morbidity, psychiatric co‐morbidity, pretrauma opioid use and severe injury. The adjusted hazard ratio for death from any cause 6–18 months after trauma for chronic opioid users was 1·82 (95 per cent c.i. 1·34 to 2·48). Findings were similar in a subset of injured patients with no pretrauma opioid exposure. Conclusion Traumatic injury was associated with chronic opioid use. These patients have an excess risk of death in the 6–18 months after trauma.

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Section: Discussionsupporting

confidence: 90%

Risk factors and outcomes of chronic opioid use following trauma

Oelreich

Eriksson

Brattström

et al. 2020

British Journal of Surgery

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“…Prior opioid use has been shown to be associated with adverse clinical outcomes in surgical and trauma patients including higher pain, greater rates of postoperative morbidity, and lower levels of satisfaction. [1][2][3] Opioid exposure in the context of a traumatic injury may also increase the potential for dependence, misuse, and abuse. [1][2][3] A history of prescription opioid abuse is a significant risk factor for conversion to heroin use.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Opioid exposure in the context of a traumatic injury may also increase the potential for dependence, misuse, and abuse. [1][2][3] A history of prescription opioid abuse is a significant risk factor for conversion to heroin use. 4 The potential for these adverse events may be even higher among patients who sustain trauma to the musculoskeletal system, a group previously found to have elevated rates of chemical dependence, risk-taking behavior, concomitant behavioral health disorders, and other sociodemographic characteristics associated with opioid abuse such as underemployment and lower socioeconomic status.…”

Section: Introductionmentioning

confidence: 99%

“…4 The potential for these adverse events may be even higher among patients who sustain trauma to the musculoskeletal system, a group previously found to have elevated rates of chemical dependence, risk-taking behavior, concomitant behavioral health disorders, and other sociodemographic characteristics associated with opioid abuse such as underemployment and lower socioeconomic status. [1][2][3]5,6 At the same time, contact with health care professionals as a result of the trauma may afford an opportunity to access resources capable of mitigating use for individuals regularly using opioids before their injury.…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies dedicated to this issue are largely limited by varying degrees of the definition around opioid dependence and, perhaps most important, challenges with respect to surveillance of opioid use both before and after the traumatic event. [1][2][3][7][8][9][10] Furthermore, investigations conducted using data from single centers, or private health care insurance carriers may not have sufficient levels of clinical variation, or inherent risk of opioid dependence in the population under study, to allow generalization to the US population as a whole.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prior Prescription Opioid Use and Its Influence on Opioid Requirements After Orthopedic Trauma

Chaudhary

Keudell

Bhulani

et al. 2019

Journal of Surgical Research

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Background: Prior opioid use has been shown to be associated with adverse outcomes in surgical and trauma patients. We sought to evaluate the influence of prior opioid use on prescription opioid requirements after orthopedic trauma. Materials and methods: This was a retrospective review of TRICARE claims (2006-2014). We evaluated the records of 11,752 patients treated for orthopedic injuries. Surveillance for prior opioid exposure extended to 6 mo before the traumatic event, with similar postinjury surveillance. Preinjury opioid use was categorized as unexposed, exposed without sustained use (nonsustained users), and sustained use (6 mo or longer of continuous opioid prescriptions without interruption). Multivariable Cox proportional hazard models were used to adjust for confounding and determine factors independently associated with the discontinuation of prescription opioid use after traumatic injury. Results: Prior opioid exposure among nonsustained users (hazard ratio 0.78; 95% CI 0.74, 0.83) and sustained use at the time of injury (hazard ratio 0.40; 95% CI: 0.35, 0.47) were associated with lower likelihoods of opioid discontinuation. Additional factors associated with lower likelihoods of opioid discontinuation included our proxy for lower socioeconomic status, history of depression or anxiety, injury severity, and intensive care unit admission. Conclusions: Prior opioid use is one of the strongest predictors of continued use following treatment, along with socioeconomic status, behavioral health disorders, and severity of injury. Appropriate discharge planning and early engagement of ancillary services in

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