The synergistic effect of preoperative opioid use and many associated preoperative predictors of poor outcome in the trauma patient population

Shea M. Comadoll, Boshen Liu, Eric Abbenhaus, John D. King, Cale A. Jacobs, Arun Aneja, Joseph R. Hsu, Paul E. Matuszewski

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Objective: The purpose of this study is to investigate if preoperative opioid use is associated with other predictors of poor outcome and the effect of these factors on complications. We hypothesized that preoperative opioid use (POU) is associated with increased rates of postoperative complications. Design: Retrospective case control study. Setting: Academic level-1 trauma center. Patients/participants: Patients with long bone, lower extremity fractures requiring operative fixation. Intervention: N/A. Main outcome measures: Postoperative hospital admissions, emergency room (ER) visits, and reoperations. Results: 399 patients (opioid naïve [ON] 80.2%, Age 38, 95% CI 35.9–39.6) were reviewed. Patients who had POU were older (P = 0.004), had higher BMI (P = 0.03), proportion of females (P < 0.001), tobacco use (P < 0.001), proportion of American Society of Anesthesiologist (ASA) class ≥ 3 (P < 0.001), and rates of substance use disorder (SUD) (P < 0.001). POU was associated with prolonged opiate use at 6 months (60.8%), 1 year (43.0%), higher rates of postoperative readmissions (18.1%), ER visits (17.2%), reoperations (17.5%), and complications (Odds Ratio [OR]: 2.4, P < 0.01). The risk of complication increased synergistically with the addition of other predictors: less than a high school education (OR: 4.6, P = 0.001); ASA class ≥3 (OR: 5.6, P < 0.001). All three factors combined also increased risk of complication synergistically (OR: 9.1, P = 0.003). Conclusions: Our study demonstrates that many predictors of poor outcome frequently accompany POU. POU combined with many of these predictors synergistically increases the risk of complication. Outcomes-based payment models should reflect this expected rate of readmissions, ER visits and complications in this group. Patients with POU should be targeted with multi-disciplinary interventions aimed to modify these risk factors.

Original languageEnglish
Pages (from-to)919-923
Number of pages5
JournalInjury
Volume51
Issue number4
DOIs
StatePublished - Apr 2020

Bibliographical note

Publisher Copyright:
© 2020

Keywords

  • Opioid use
  • Preoperative opioid use
  • Risk factors

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

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