Long-term opioid use in operatively managed orthopaedic patients with fracture-related infections: A data linkage...

Fracture-related infection (FRI) is a devastating complication of musculoskeletal trauma. Pain and poor functional outcomes are common, however there is limited insight to the long-term opiate use in this cohort. This study aims to 1) compare the rate of chronic opiate use between trauma patients with and without FRI, and 2) identify risk factors for chronic opiate use among patients with FRI.

A cohort of adult injured patients hospitalized in Queensland, Australia between 2014 and 2015 undergoing operative fracture management was extracted from the Community Opioid Dispensing after Injury (CODI) study. This included person-linked hospitalization clinical data, community opioid dispensing and mortality. Data were extracted from 3-months prior to the index-hospitalization to 2-years after discharge. Community opioid dispensing was compared for patients with and without FRI. Increased risk of chronic opiate therapy (COT) (≥90 days cumulatively) was examined using multivariable logistic regression, odds ratios (OR) and 95 % Confidence Intervals (95 % CI).

There were 19,218 operatively managed orthopaedic trauma patients, of which 394 (2.1 %) were complicated with FRI. Opioids were dispensed post injury for 9399 patients. Patients with FRI were more likely to be prescribed opioids (68 %) than patients without FRI (48.5 %, p < 0.001). COT was associated with FRI, with 29.0 % of infected patients being dispensed opiates >90 days (23.8 % no FRI group, p < 0.001). The median duration of opiate therapy among patients with FRI who were dispensed opiates was 60 days [IQR 15-237] (versus 23 days [IQR 15-84] for no FRI, p < 0.001) and the median end dose was 14 mg oral morphine equivalent for both groups [FRI IQR 10-30; No FRI IQR 10-28]. Among patients with FRI, pre-injury opiates, high injury severity, length of stay >21 days and >2 revision surgeries were associated with COT.

Infection following trauma surgery is associated with long term opiate use. Risk factors identified for with COT include pre-injury opiate use, high injury severity, increased length of stay and multiple revision surgeries. These insights should be utilised to guide opiate stewardship programs, advocate for improved prevention and treatment strategies for FRI and optimise physical and mental rehabilitation.