Walter Robert Hsiang1, Catherine McGeoch2, Sarah Lee3, William Cheung4, Robert Becher5, Kimberly A Davis6, Kevin Schuster7. 1. Yale School of Medicine, Section of General Surgery, Trauma, and Surgical Critical Care, United States. Electronic address: walter.hsiang@yale.edu. 2. Yale School of Medicine, Section of General Surgery, Trauma, and Surgical Critical Care, United States. Electronic address: catherine.mcgeoch@yale.edu. 3. Yale School of Medicine, Section of General Surgery, Trauma, and Surgical Critical Care, United States. Electronic address: sarah.lee.sl2437@yale.edu. 4. Yale School of Medicine, Section of General Surgery, Trauma, and Surgical Critical Care, United States. Electronic address: w.cheung@yale.edu. 5. Yale School of Medicine, Section of General Surgery, Trauma, and Surgical Critical Care, United States. Electronic address: robert.becher@yale.edu. 6. Yale School of Medicine, Section of General Surgery, Trauma, and Surgical Critical Care, United States. Electronic address: kimberly.davis@yale.edu. 7. Yale School of Medicine, Section of General Surgery, Trauma, and Surgical Critical Care, United States. Electronic address: kevin.schuster@yale.edu.
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.
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 painpatients, 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 traumapatients 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.
Authors: Evelyn I Truong; Sami K Kishawi; V P Ho; Roshan S Tadi; David F Warner; Jeffrey A Claridge; Esther S Tseng Journal: Injury Date: 2021-03-10 Impact factor: 2.687