Patterns and predictors of opioid prescribing and use after rib fractures

Rib fractures are painful injuries that are treated with aggressive analgesia, which can include opioids. We sought to evaluate the patterns and predictors of opioid prescription and sustained use for rib fracture patients to identify opportunities for opiate reduction.

We used TRICARE claims data (2006-2014) to identify adult (18-64 years) patients presenting to the emergency department with rib fracture(s) and isolated chest trauma. We used logistic regression and Cox proportional hazards model to identify factors associated with opioid prescription and duration of use.

We identified 29,943 patients meeting inclusion criteria, and 2,542 (9%) patients were prescribed opioids. When prescribed, the median duration opioid use was 16 days (interquartile range 6-31) for opioid naïve patients, compared with 36 days (interquartile range 15-134) for those with prior opioid exposure. Increased number of ribs fractured (6+ fractures) (odds ratio 2.96 [95% confidence interval 2.23-3.94], P < .001) and prior opioid exposure (odds ratio 32.95 [29.36-36.99], P < .001) were significant predictors of initial opioid prescription. Patients with prior opioid exposure (hazard ratio 0.47 [0.43-0.52], P < .001) had lower likelihood of opioid discontinuation. Injury characteristics did not significantly predict discontinuation.

Prior opioid exposure was the strongest predictor of sustained opioid use after rib fractures, while the severity of injury did not predict the duration of use.