Risk Factors and Pooled Rate of Prolonged Opioid Use Following Trauma or Surgery

Mohamadi, Amin; Chan, Jimmy J.; Lian, Jayson; Wright, Casey L.; Marin, Arden M.; Rodriguez, Edward K.; Keudell, Arvind von; Nazarian, Ara

doi:10.2106/jbjs.17.01239

Cited by 81 publications

(93 citation statements)

References 64 publications

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“…A strong risk factor for chronic opioid use was preinjury opioid consumption. Previous studies have shown similar findings in both orthopaedic and trauma 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.…”

Section: Discussionsupporting

confidence: 76%

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: 76%

Risk factors and outcomes of chronic opioid use following trauma

Oelreich

Eriksson

Brattström

et al. 2020

British Journal of Surgery

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“…Two recent systematic reviews have reported rates of persistent opioid use following surgery (16,22). Mohamadi et al (22) reported an overall rate of prolonged use of 4.3% BOX 1 | De ning the problems.…”

Section: Persistent Use Of Opioids After Surgerymentioning

confidence: 99%

“…Importantly, these reviews also highlighted several patientrelated risk factors for postoperative use, including opioid use prior to surgery, benzodiazepine use, pain catastrophizing, depression, smoking, and preoperative pain conditions (16,22). In addition to this, while both major and minor surgeries place patients at risk of developing persistent opioid use, Mohamadi et al (22) reported that more invasive procedures were associated with greater odds persistent postoperative use. Each of these risk factors can be understood as a potential target for interventions aimed at reducing rates of persistent postoperative use.…”

Section: Persistent Use Of Opioids After Surgerymentioning

confidence: 99%

“…Incidence of persistent postoperative opioid use in moderate quality studies reviewed by Kent et al(16).in non-naïve hip and knee replacement, and abdominopelvic patients when compared to opioid naïve patients. Mohamadi et al(22) reported that preoperative use was associated with roughly 11 times greater odds of long-term postoperative use (OR = 11.04 [95% CI 9.39-12.97])…”

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confidence: 99%

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The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

et al. 2020

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“…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%

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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Risk Factors and Pooled Rate of Prolonged Opioid Use Following Trauma or Surgery

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

Cited by 81 publications

References 64 publications

Risk factors and outcomes of chronic opioid use following trauma

Risk factors and outcomes of chronic opioid use following trauma

The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

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

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