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

• Published in: Injury Vol. 51; no. 4; pp. 919 - 923
• Main Authors: Comadoll, Shea M., Liu, Boshen, Abbenhaus, Eric, King, John D., Jacobs, Cale A., Aneja, Arun, Hsu, Joseph R., Matuszewski, Paul E.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2020
• Subjects: Adolescent; Adult; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Emergency Service, Hospital - statistics & numerical data; Female; Fractures, Bone - surgery; Humans; Lower Extremity - surgery; Male; Middle Aged; Opioid use; Patient Readmission - statistics & numerical data; Perioperative Care - adverse effects; Postoperative Complications - epidemiology; Postoperative Period; Preoperative opioid use; Regression Analysis; Reoperation - statistics & numerical data; Retrospective Studies; Risk Factors; Trauma Centers; Young Adult; Preoperative opioid use; Opioid use; Risk factors
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2020.02.114

•Many predictors of poor outcome are associated with preoperative opioid use (POU) including poor education & increased BMI, ASA, and tobacco use.•POU combined with many of these predictors synergistically increases the risk of complications including readmissions and reoperations.•Patients with POU should be targeted with multi-disciplinary interventions aimed to modify these risk factors.•Outcomes-based payment models should reflect this higher expected rate of readmissions, ER visits, and complications in POU patients. 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. Retrospective case control study. Academic level-1 trauma center. Patients with long bone, lower extremity fractures requiring operative fixation. N/A. Postoperative hospital admissions, emergency room (ER) visits, and reoperations. 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). 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.