Socio-environmental Determinants of Post-operative Inpatient Opioid Consumption in Orthopedic Trauma Patients Open Access
Liew, Amanda (Spring 2020)
Purpose: The opioid epidemic in the United States is a growing problem with tragic consequences. Recent studies have investigated whether post-discharge prescription opioid use has implications on long-term use and substance abuse. Orthopedic trauma patients often come in with severe injuries warranting surgical interventions and prolonged hospitalizations. Prescription opioid analgesics are often the gold standard for pain relief in an inpatient setting. There are various factors, both clinical and environmental in nature, that may increase an individual’s risk for developing substance abuse behaviors. The purpose of this study is to better understand patterns of inpatient opioid consumption, as well as associations with clinical and environmental predictors.
Methods: The study sample consisted of 173 patients treated for operative orthopedic. Average opioid consumption over a post-surgical period (defined as the time period between the patient’s last surgery and discharge) was assessed and converted into oral morphine equivalents (OME). Maximum consumption, which is the peak OME dose received in a day, was also recorded as an outcome. Socio-environmental determinants were assessed with a survey, and the variables included in analysis were gender, age, post-operative days, number of surgeries, injury severity score (ISS), use of non-narcotic adjuvants, substance abuse history, and mental illness diagnosis. Distressed Communities Index (DCI), a measure used to evaluate a community’s well-being by zip code, was included as a predictor. A multivariate linear regression model was used for analysis.
Results: 61% of the population was male, and the mean age was 46.7 ± 17.4. Average dose was 49.7 ± 25.8 OME/day, and maximum dose was 78.5 ± 39.7 OME. A log-transformed multivariate linear regression model revealed that average daily dose was inversely correlated with age (RSE=0.63, F(13,159)=2.98), and maximum dosage was inversely correlated with age, and directly correlated with number of post-operative days (RSE=0.63, F(13,159)=2.98). No other predictors were significantly associated with either outcome.
Conclusion: Age was inversely correlated with both average and maximum dose, and the number of post-operative days was positively associated with maximum dose. Future studies with larger sample sizes are recommended in order to better understand inpatient opioid consumption trends and the associations with socio-environmental predictors.
Table of Contents
CHAPTER I: BACKGROUND & LITERATURE REVIEW
CHAPTER II: MANUSCRIPT
CHAPTER III: CONCLUSIONS & RECOMMENDATIONS
TABLES & FIGURES
About this Master's Thesis
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