Risk Factors for Prolonged Opioid Use after Orthopedic Trauma: Inner-City Hospital versus Community Hospital

Abstract

Abstract Introduction Prescription opiate use has exponentially increased. The aim of this study was to identify risk factors associated with prolonged opioid use (> 12 weeks) after isolated orthopedic trauma requiring surgery, and compare two different hospital settings: a large community based hospital vs. inner-city hospital. Methods A retrospective review was performed of adult trauma patients requiring operative fixation of their isolated long bone fractures at two Level I trauma centers between 2011-2016. Patients were identified using CPT codes for fracture fixation. Demographics, fracture type, mechanism of injury (MOI), index procedure, medical/psychiatric history, employment status at time of injury, drug screen, blood alcohol and smoking status at presentation, insurance type/status, preinjury opioid use, and duration of opioid use postoperatively was collected. The primary outcome was the duration of opioid use postoperatively, stratified < 6 weeks, 6-12 weeks, or > 12 weeks. Categorical variables analyzed using chi-square and t-test used for continuous variables. Results 196 patients were included (115 inner-city and 81 community hospital). The mean age was 38.4 ± 15 years, 68% were male, the mean ISS 7 ± 3. With results stratified by opioid duration: MOI (P = 0.023), smoking (P = 0.001), drug use (P = < 0.001), and insurance type (P = 0.005) were significantly different between those who stop using opioids by six weeks vs. those who didn’t. Employment status (P=0.046), smoking (P = 0.001), drug use (P<0.001), insurance type (P = 0.025), and preinjury opioid use (P = 0.024) were significantly different between those who stop using opioids by 12 weeks vs. those with continued using opioids. In both hospital settings, positive drug screen and current smokers were associated with increased risk of prolonged opioid use (P ≤ 0.001). Conclusion Risk factors for prolonged opioid use were insurance type, employment status, and preinjury opioid use. In addition, patients with positive drug screen or current smokers were at an increased risk regardless of hospital setting. These findings can help identify patients who would benefit from a different treatment approach, but further studies are needed to determine the best intervention for these high risk patients.