Opioid dependency is independently associated with inferior clinical outcomes after trauma. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Hsiang, Walter Robert; McGeoch, Catherine; Lee, Sarah; Cheung, William; Becher, Robert; Davis, Kimberly A.; Schuster, Kevin
• Is Part Of: Injury. Volume 50:Issue 1(2019)
• Page Start: 192
• Page End: 196
• Publication Date: 2019-01
• Subjects: Opioid dependence -- Trauma -- Outcomes -- Length of stay -- Readmissions; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2018.10.015
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Opioid dependence was common among an unselected group of trauma patients at 18%. Length of stay and ventilator days were greater in opioid dependent patients, mortality and complications were similar. By sub-groups, prescription drug abusers, illicit drug abusers and chronic pain users all had higher rates of readmission. Abstract: Introduction: Increased use of opioids has led to higher rates of overdose and hospital admissions. Studies in trauma populations have focused on outcomes associated with acute intoxications rather than addiction. We hypothesize that clinical outcomes after injury would be inferior for opioid-dependent patients compared to opioid-naïve patients. Methods: We identified all opioid-dependent adult patients admitted to an academic level I trauma center in 2016 with an Injury Severity Score (ISS) ≥ 5. Patients were further categorized by their pattern of opioid dependency into prescription abuse, illicit abuse, or chronic pain subgroups. Outcome measures included length of stay (LOS), major complications, mortality, non-home discharge, ventilator days, and readmissions. Regression models were adjusted for patient demographics, insurance, ISS, and comorbidities. Results: Of the 1450 patients who met the inclusion criteria, 18% were opioid-dependent. Among opioid-dependent patients, 30%, 27%, and 43% were prescription abuse, illicit abuse, and chronic pain patients, respectively. Compared to opioid-naïve (non-users) patients, opioid-dependent patients had longer LOS, more ventilator days, more non-home discharges, and higher readmission rates. Subgroup analysis revealed significant differences among all cohorts when compared to non-users in LOS, non-home discharge, readmissions, and major complications. Opioid dependency was not associated with mortality. Conclusion: Opioid dependency was detected in 18% of trauma patients and was independently associated with inferior outcomes. The impact of opioid dependency affects each opioid subgroup differently with all cohorts demonstrating increased 30-day readmissions. Opioid dependent patients may be targeted for risk interventions to reduce LOS, non-home discharge, complications and readmissions.