Background & Aims
Pain from trauma sustained injuries often requires inpatient management with opiate medication. A significant number of trauma patients require repeat surgical procedures, and some develop infections and transition to post traumatic persistent pain requiring ongoing analgesia including opiate prescription. Approximately one in four of trauma patients utilise pain medications at one year (1). Considering limited health care resources there is a need to identify and target at risk populations for persistent pain within the trauma population. A deeper understanding of ongoing analgesia use is required to enable targeted multidisciplinary team management along the journey of these complex patients to minimise the individuals risks for transition to post traumatic persistent pain. The aim of this study is to examine opioid dispensing patterns for patients with fractures and the influence of repeat surgeries on long duration and high dose opiate dispensing.
Methods
A cohort of adult injured patients hospitalised in Queensland, Australia between 2014 and 2015 with a primary diagnosis of a fracture was extracted from the CODI study, (2, 3) which included person-linked hospitalisation and community opioid dispensing data. Data were extracted 90-days prior to the index hospitalisation and 720 days after discharge. All surgeries post index hospitalisation were identified for up to two years. The number of subsequent surgeries irrespective of the surgical procedures that occurred during the index hospitalisation were identified and grouped as ‘low surgery’ defined as zero to one and ‘high surgery’ defined as two or more. Community opioid dispensing patterns were compared for patients with low surgery and high surgery. Increased risk of long-duration opioid dispensing (>90 days cumulatively) and higher opioid end-dose were examined using multivariable logistic regressions, odds ratios (OR) and 95% Confidence Intervals (95% CI).
Results
A total of 38,039 fracture patients were identified, of which 51.8% were dispensed opioids in the community post hospitalisation, 50.2% were female, 35.0% were age 65 or over and 21.0% were classified as having a high number of surgical procedures during the study period. Throughout the follow-up period the proportion of patients dispensed opioids in the community was 1.6 times higher for those with high number of surgeries compared with patients with a low number of surgeries, remaining at 11.2% and 6.6% respectively at the end of the 2-years. After controlling for age, sex, Indigenous status, rurality, prior opioid use, injury severity and infection during the study period, among those who received opioids, patients with high number of surgeries had significantly higher odds of long-duration opioid use (OR=1.8, 95% CI 1.6-1.9) and an increased opioid end-dose (OR=1.4, 95% CI 1.2-1.5) compared to those with low surgery.
Conclusions
The study examined community base opioid dispensing of trauma patients, with a primary diagnosis of a fracture who post index hospitalisation required surgical intervention/s. The patients with two or more subsequent surgeries were 1.6 times more likely to have opiates dispensed, for a longer duration with a higher end dose. This included adjustment for confounding factors including age, sex, Aboriginal and Torres Strait Islanders, rurality, prior opioid use, injury severity and infection. Further research and subsequent development of a proactive multidisciplinary model of care to support this complex group is warranted.
References
(1) Constantine S. Velmahos, Juan P. Herrera-Escobar, Syeda S. Al Rafai, Shelby Chun Fat, Haytham Kaafarani, Deepika Nehra, George Kasotakis, Ali Salim, Adil H. Haider,
It still hurts! Persistent pain and use of pain medication one year after injury,
The American Journal of Surgery, Volume 218, Issue 5,2019, Pages 864-868, ISSN 0002-9610,
https://doi.org/10.1016/j.amjsurg.2019.03.022.
(2) CM Cameron, R Shibl , S Cramb, V McCreanor, M Proper, J Warren, T Smyth, HE Carter, K Vallmuur, N Graves, N Bradford, B Loveday (2024) Community Opioid Dispensing after Injury (CODI): Cohort characteristics and opioid dispensing patterns. Injury, 55, (2024) 111216
(3) CM Cameron, V McCreanor, R Shibl, T Smyth, M Proper, J Warren, K Vallmuur, N Bradford, HE Carter, N Graves, B Loveday
Community Opioid Dispensing After Injury (CODI): Protocol for a Population-Based Data Linkage Study. DHS. JMIR Res Protoc (2022) vol. 11, iss. 4, e36357
(4) G. Lorimer Moseley, Hayley B. Leake, Anneke J. Beetsma, James A. Watson, David S. Butler, Annika van der Mee, Jennifer N. Stinson, Daniel Harvie, Tonya M. Palermo, Mira Meeus, Cormac G. Ryan,
Teaching Patients About Pain: The Emergence of Pain Science Education, its Learning Frameworks and Delivery Strategies, The Journal of Pain, Volume 25, Issue 5, 2024, 104425, ISSN 1526-5900,
https://doi.org/10.1016/j.jpain.2023.11.008.
Presenting Author
Melanie Proper
Poster Authors
Melanie Proper
Master of Nursing Science (NP)
Royal Brisbane & Women’s Hospital, Metro North Health, Brisbane, Australia
Lead Author
Frances Williamson
Royal Brisbane and Womens Hospital
Lead Author
Jacelle Warren
BSc
Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital, Metro North Health
Lead Author
Rania Shibl
BSc
School of Science Technology and Engineering, University of the Sunshine Coast, Petrie, QLD, Austral
Lead Author
Susanna Cramb
Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of
Lead Author
Cate M Cameron
BSW (Hons)
Jamieson Trauma Institute, Royal Brisbane and Women’s Hospital, Metro North Health
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Acute Pain and Nociceptive Pain