Association for Academic Surgery
Impact of preexisting opioid use on injury mechanism, type, and outcome

https://doi.org/10.1016/j.jss.2015.05.033Get rights and content

Abstract

Background

The prevalence of prescription narcotic use in the United States is on the rise. Opioid use and its impact on the management of trauma patients has yet to be thoroughly studied. The aim of this study was to determine the prevalence of preinjury opioid use and its influence on specific outcomes among the trauma patient population.

Methods

A retrospective review of all trauma patients presenting to a level 1 trauma center was performed from January 1, 2010–December 31, 2010. Patients who died within 24 h of presentation and those with incomplete medication data were excluded. Electronic medical record review of history and physical documentation and urine drug screen records were used to determine preinjury opioid status. Preexisting narcotic use, demographic data, injury mechanism and severity, injury type, and outcome variables were analyzed.

Results

A total of 3953 patients met inclusion criteria. Among our sample, 644 (16.3%) were positive for preinjury opioid use. Patients in the preinjury opioid group were older (48 versus 41 y) and more likely to be female (37.9% versus 30.6%). The mechanism of injury was more often falls (32.8% versus 22.0%). Analysis of less severely injured patients (ISS <15) found a significantly increased length of stay (3.7 versus 2.9 d) in the narcotics group. Evaluation of injury type revealed that head injury, abdominal injury, and lower extremity and/or pelvic injuries had significantly increased length of stay.

Conclusions

There is a considerable prevalence of preinjury opioid use in the trauma population. These patients have unique characteristics and causes of injury. Preinjury opioid use is predictive of increased length of stay, with important ramifications for patient care and health care costs.

Introduction

The increasing prevalence of prescription opioid analgesics in the United States over the past decade has been well documented. Opioid prescriptions per 100 persons in the United States increased by 35.2% during the period 2000–2009 [1]. It is estimated that in 2011, opioid analgesics were prescribed over 238 million times [2]. Escalation of the use of illicit opioids has also contributed to the overall prevalence of narcotics with an estimated 5.1 million Americans aged ≥12 y having used narcotic pain relievers in the past month [2]. Determining the true prevalence of opioid use is challenging. According to the National Center for Health Statistics, 4.2% of US adults reported the use of opioid analgesics for pain within the prior month from 1999–2002 [2], [3]. Another report estimated that 4.9% of adults used opioids regularly, based on random phone interviews from 1998–2006 [4].

Although prescription narcotics are an important component of the management of acute and chronic pain, the adverse effects of such drugs have become an area of increased concern. Numerous studies have reported an association between opioid prescribing and poorer health status including increased disability, medical costs, and subsequent surgery [2], [5], [6]. The impact that these medications have on the trauma population is uncertain. Increased pain tolerance, withdrawal, and poorer outcomes are all potential ramifications of increasing opioid use in the public. There have been many previous studies documenting the use of narcotics and pain control for injured patients after trauma but few have addressed the influence that preinjury narcotic use has on trauma outcomes.

With such an overall increase in the use of prescription narcotics, hospitals and trauma centers are faced with the challenge of managing acute pain in patients who have already developed some degree of tolerance to opioids before presentation. Consequently, it would be reasonable to conclude that the management of such patients would be more complex resulting in potentially worse outcomes. The purpose of this study was to determine the prevalence of preinjury narcotic use in the trauma population at a level 1 trauma center and define the characteristics of these patients. We hypothesize that preinjury narcotic use impacts hospital length of stay and seeks to characterize this potential effect. Finally, we seek to determine whether patients who take narcotics before their injury have different injury characteristics and clinical course as a result of their preexisting use of pain medication as compared with the remainder of the trauma population.

Section snippets

Methods

Approval for this study was obtained from the Institutional Review Board at Grant Medical Center, an adult level 1 trauma center in Columbus, OH, with approximately 4000 trauma admissions annually. This retrospective review included 4352 consecutive patients obtained from the trauma registry database over a 12-month period from January 1, 2010–December 31, 2010. A total of 239 patients who were not seen or evaluated by the trauma surgery service were excluded leaving 4113 patients for initial

Results

Data from 4352 patients were gathered from the trauma database. Patients not seen by the trauma service, dying within 24 h of presentation, and those with absent or incomplete data were excluded leaving 3953 patients for analysis. Table 1 shows baseline characteristics of the patient population. Mean age was 42.3 y (range 16–102). There were 2696 males (68.2%) versus 1257 females (31.8%). Patients presented as category 1 trauma alert (12.7%), category 2 trauma alert (70.0%), or consultations

Discussion

Much has been written in the past few years about the increasing epidemic of opioid use and abuse in the United States. Though narcotic pain medications are often prescribed in an effort to better treat acute and chronic pain, the dramatic and continued increase deserves attention. Climbing numbers of prescriptions as well as the rise in illicit use has resulted in increased consumption of narcotics in the United States. Sales of opioid analgesics quadrupled from 1999–2010 [2]. With this

Acknowledgment

The authors acknowledge the assistance of Ed Buggie in organization and statistical analysis of the data.

Authors' contributions: U.P., M.S.O., and J.O designed this study. U.P, J.O, and W.W. performed the literature search. U.P., M.L., and W.W performed the data collection. U.P., M.S.O., M.L., W.W., and J.O. interpreted the data. U.P. wrote the article. U.P., M.S.O., W.W., M.L., and J.O. contributed to the critical revision of the article.

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