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Sustained Prescription Opioid Utilization Following Thoracic and Lumbar Fractures in a Cohort of Over 1000
Brendan M Striano1, Alexander M Crawford2, Mark C Lawlor1
1Massachusetts General Brigham Combined Spine Fellowship, Boston, MA.
Study Design:
Retrospective cohort study.
Objective:
To characterize opioid utilization after thoracic and lumbar spine fractures and identify risk factors for sustained opioid use.
Summary Of Background Data:
Thoracic and lumbar spine fractures are common injuries, but despite their frequency, little detailed information is available regarding post-injury pain management. In the setting of the opioid epidemic, it is important to understand opioid utilization patterns after these common spine fractures.
Methods:
We conducted as a retrospective review of patients who presented to any of four hospitals in a large academic medical system in a major metropolitan area and who were identified to have thoracic or lumbar spine fractures, excluding those in the setting of metastatic disease or infection. Administrative data were used to track opioid prescriptions with persistent use defined as receipt of opioid prescriptions in both the 42-day and 42 to 90-day time windows after injury. Associations with persistent opioid utilization were determined using multivariable logistic regression.
Results:
We found that 73.1% (762/1042) of patients with thoracic or lumbar fractures were prescribed opioids in the first 6 weeks after injury, and 11.9% (124/1042) were persistently prescribed opioids in the 90 days after injury. Charlson Comorbidity Index (OR 1.20, 95% CI 1.09-1.32, P <0.001), pre-injury opioid exposure (OR 2.64, 95% CI 1.33-5.14, P < 0.01), and surgical treatment (OR 2.42, 95% CI 1.11-5.13, P =0.02) were all significantly associated with persistent opioid utilization in multivariable analysis.
Conclusion:
Opioid pain medications are very commonly prescribed in the acute period after thoracic and lumbar fractures. Despite six weeks being commonly reported as the initial healing window for these fractures, nearly 12% of patients were persistently prescribed opioids at the 90-day post-injury mark. These data help characterize opioid exposure after fracture and identify important prognostic indicators that can be used to help risk stratify patients at elevated risk for persistent opioid use.
Level Of Evidence:
Level III.
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