Predictors of Prescription Opioid Use 4 Months After Traumatic Musculoskeletal Injury and Corrective Surgery: A Prospective Study

Rosenbloom, Brittany N.; McCartney, Colin J. L.; Canzian, Sonya; Kreder, Hans J.; Katz, Joel

doi:10.1016/j.jpain.2017.03.006

Cited by 51 publications

(44 citation statements)

References 35 publications

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“…For example, in a systematic review, Mohamadi et al 8 reported that longer hospital length of stay and history of depression were among the strongest predictors of prolonged opioid use after trauma. Rosenbloom et al 10 came to a similar conclusion, maintaining that perceptions of pain severity and selfefficacy, clinically important factors modulated by an individual's behavioral health state, were associated with prescription opioid use up to 4 mo after musculoskeletal trauma. The importance of ICU admission and prior history of substance use was highlighted in the work of Flanagan et al 1 Particularly striking is our finding regarding the influence of the proxy for lower socioeconomic status (Junior Enlisted), which demonstrated a 28% reduction in the likelihood of opioid discontinuation as compared to the referent group (Officers; HR 0.72; 95% CI 0.65, 0.78).…”

Section: Opioid Use Characteristicsmentioning

confidence: 77%

“…1,2,7,8 Prior research among surgical cohorts has demonstrated that sustained prescription opioid use is associated with increased perioperative morbidity, higher pain medication requirements, and decreased physical function. 2,3,[8][9][10] Among patients who sustain orthopedic trauma, regular opioid use has previously been shown to lower the likelihood of patient satisfaction 2,3 and increase the risk of nonunion. 9 One of the most substantive concerns around the use of prescription opioids in a trauma population is the potential for long-term sustained use after injury, especially in Table 1 e Demographics and clinical characteristics of orthopedic trauma patients.…”

Section: Discussionmentioning

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%

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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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Section: Opioid Use Characteristicsmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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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“…The definitions of opioid therapy during the time windows within the follow-up time were not strict and many definitions only required one opioid prescription during a predefined time period for LTOT. 40,[43][44][45][46][47][48][49][50][51][52][53][54] For example, one study defined LTOT as at least one prescription 305 to 425 days after a hospital discharge. 44 By only requiring one prescription during a specified window of time after the index date, these definitions fail to identify consistent use.…”

Section: /1002 = 57%mentioning

confidence: 99%

Long‐term opioid therapy definitions and predictors: A systematic review

Karmali

Bush

Raman

et al. 2019

Pharmacoepidemiology and Drug

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Purpose This review sought to (a) describe definitions of long‐term opioid therapy (LTOT) outcome measures, and (b) identify the predictors associated with the transition from short‐term opioid use to LTOT for opioid‐naïve individuals. Methods We conducted a systematic review of the peer‐reviewed literature (January 2007 to July 2018). We included studies examining opioid use for more than 30 days. We classified operationalization of LTOT based on criteria used in the definitions. We extracted LTOT predictors from multivariate models in studies of opioid‐naïve individuals. Results The search retrieved 5,221 studies, and 34 studies were included. We extracted 41 unique variations of LTOT definitions. About 36% of definitions required a cumulative duration of opioid use of 3 months. Only 17% of definitions considered consecutive observation periods, 27% used days' supply, and no definitions considered dose. We extracted 76 unique predictors of LTOT from seven studies of opioid‐naïve patients. Common predictors included pre‐existing comorbidities (21.1%), non‐opioid prescription medication use (13.2%), substance use disorders (10.5%), and mental health disorders (10.5%). Conclusions Most LTOT definitions aligned with the chronic pain definition (pain more than 3 months), and used cumulative duration of opioid use as a criterion, although most did not account for consistent use. Definitions were varied and rarely accounted for prescription characteristics, such as days' supply. Predictors of LTOT were similar to known risk factors of opioid abuse, misuse, and overdose. As LTOT becomes a central component of quality improvement efforts, researchers should incorporate criteria to identify consistent opioid use to build the evidence for safe and appropriate use of prescription opioids.

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“…perception and self-modulation of pain [17][18][19][20] . Further research is required to explore how non-pharmacologic techniques of pain management as well as patient expectation management are employed in different contexts and how such differences might inform domestic opioid prescribing practices.…”

Section: Discussionmentioning

confidence: 99%

Cross-Cultural Comparison of Postoperative Discharge Opioid Prescribing After Orthopaedic Trauma Surgery

Young

Bhashyam

Qudsi

et al. 2019

The Journal of Bone and Joint Surgery

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Background: The extent of variation in analgesic prescribing following musculoskeletal injury among countries and cultural contexts is poorly understood. Such an understanding can inform both domestic prescribing and future policy. The aim of our survey study was to evaluate how opioid prescribing by orthopaedic residents varies by geographic context. Methods: Orthopaedic residents in 3 countries in which residents are the primary prescribers of postoperative analgesia in academic medical centers (Haiti, the Netherlands, and the U.S.) responded to surveys utilizing vignette-based musculoskeletal trauma case scenarios. The residents chose which medications they would prescribe for post-discharge analgesia. We standardized opioid prescriptions in the surveys by conversion to morphine milligram equivalents (MMEs). We then constructed multivariable regressions with generalized estimating equations to describe differences in opiate prescription according to country, the resident's sex and training year, and the injury site and age in the test cases. Results: U.S. residents prescribed significantly more total MMEs per case (mean [95% confidence interval] = 383 [331 to 435]) compared with residents from the Netherlands (229 [160 to 297]) and from Haiti (101 [52 to 150]) both overall (p < 0.0001) and for patients treated for injuries of the femur (452 [385 to 520], 315 [216 to 414], and 103 [37 to 169] in the U.S., the Netherlands, and Haiti, respectively), tibial plateau (459 [388 to 531], 280 [196 to 365], and 114 [46 to 183]), tibial shaft (440 [380 to 500], 294 [205 to 383], and 141 [44 to 239]), wrist (239 [194 to 284], 78 [36 to 119], and 63 [30 to 95]), and ankle (331 [270 to 393], 190 [100 to 280], and 85 [42 to 128]) (p = 0.0272). U.S. residents prescribed significantly more MMEs for patients <40 years old (432 [374 to 490]) than for those >70 years old (327 [270 to 384]) (p = 0.0019). Conclusions: Our results demonstrate greater prescribing of postoperative opioids at discharge in the U.S. compared with 2 other countries, 1 low-income and 1 high-income. Our findings highlight the high U.S. reliance on opioid prescribing for postoperative pain control after orthopaedic trauma. Clinical Relevance: Our findings point toward a need for careful reassessment of current opioid prescribing habits in the U.S. and demand reflection on how we can maximize effectiveness in pain management protocols and reduce provider contributions to the ongoing opioid crisis. M usculoskeletal injuries are responsible for a large global burden of preventable injuries, disability, and death 1,2. In the U.S., opioid prescribing for such conditions is currently considered problematic and appears to be a major factor contributing to what is considered an opioid epidemic by bodies such as the Centers for Disease Control and Prevention (CDC) 3-5. Over the past 20 years, U.S. opioid prescriptions and opioid-related deaths have increased greatly 5. U.S. physicians and policymakers have attempted to address the opioid crisis by curtailing the freq...

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Predictors of Prescription Opioid Use 4 Months After Traumatic Musculoskeletal Injury and Corrective Surgery: A Prospective Study

Cited by 51 publications

References 35 publications

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

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

Long‐term opioid therapy definitions and predictors: A systematic review

Cross-Cultural Comparison of Postoperative Discharge Opioid Prescribing After Orthopaedic Trauma Surgery

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