Dataset Information

Long term opioid use after burn injury: a retrospective cohort study.

ABSTRACT:

Background

Patients who have survive a burn injury might be at risk of opioid dependence after discharge. This study examined the use of opioids in patients who suffer burn injury and explored factors associated with persistent opioid use after hospital discharge.

Methods

This retrospective cohort study compared adults admitted with a burn injury from 2009 to 2019 with two matched comparison cohorts from the general population and adults with a diagnosis of acute pancreatitis. Pre-admission prescription opioid use was determined, and a multivariable negative binomial regression analysis used to explore post-discharge opioid use.

Results

A total of 7147 burn patients were matched with 6810 pancreatitis patients and with 28 184 individuals from the general population. Pre-admission opioid use was higher in the burn and pancreatitis cohorts (29% and 40%, respectively) compared with the general population (17%). Opioid use increased in both burn and pancreatitis cohorts after discharge (41% and 53%, respectively), although patients with pancreatitis were at even higher risk of increased opioid use in an adjusted analysis (incidence rate ratio 1.43). Female sex, lower socioeconomic status, ICU admission, pre-injury opioid use, and a history of excess alcohol use were all associated with an increase in opioid prescriptions after discharge.

Conclusions

Opioid use is high in those admitted with a burn injury or acute pancreatitis when compared with the general population, increasing further after hospital discharge. Female sex and socioeconomic deprivation are among factors that make increased opioid use more likely, although this phenomenon seems even more pronounced in those with acute pancreatitis compared with burn injuries.

SUBMITTER: Jamal S

PROVIDER: S-EPMC10870133 | biostudies-literature | 2024 Mar

REPOSITORIES: biostudies-literature

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Publications

Long term opioid use after burn injury: a retrospective cohort study.

Jamal Sherzah S Shaw Martin M Quasim Tara T Puxty Kathryn K McGovern Christopher C

British journal of anaesthesia 20240111 3

<h4>Background</h4>Patients who have survive a burn injury might be at risk of opioid dependence after discharge. This study examined the use of opioids in patients who suffer burn injury and explored factors associated with persistent opioid use after hospital discharge.<h4>Methods</h4>This retrospective cohort study compared adults admitted with a burn injury from 2009 to 2019 with two matched comparison cohorts from the general population and adults with a diagnosis of acute pancreatitis. Pre ...[more]

PMID: 38216388

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Project description:BackgroundLong-term efficacy of opioids for non-cancer pain is unproven, but risks argue for cautious prescribing. Few data suggest how long or how much opioid can be prescribed for opioid-naïve patients without inadvertently promoting long-term use.ObjectiveTo examine the association between initial opioid prescribing patterns and likelihood of long-term use among opioid-naïve patients.DesignRetrospective cohort study; data from Oregon resident prescriptions linked to death certificates and hospital discharges.ParticipantsPatients filling opioid prescriptions between October 1, 2012, and September 30, 2013, with no opioid fills for the previous 365 days. Subgroup analyses examined patients under age 45 who did not die in the follow-up year, excluding most cancer or palliative care patients.Main measuresExposure: Numbers of prescription fills and cumulative morphine milligram equivalents (MMEs) dispensed during 30 days following opioid initiation ("initiation month").OutcomeProportion of patients with six or more opioid fills during the subsequent year ("long-term users").Key resultsThere were 536,767 opioid-naïve patients who filled an opioid prescription. Of these, 26,785 (5.0 %) became long-term users. Numbers of fills and cumulative MMEs during the initiation month were associated with long-term use. Among patients under age 45 using short-acting opioids who did not die in the follow-up year, the adjusted odds ratio (OR) for long-term use among those receiving two fills versus one was 2.25 (95 % CI: 2.17, 2.33). Compared to those who received < 120 total MMEs, those who received between 400 and 799 had an OR of 2.96 (95 % CI: 2.81, 3.11). Patients initiating with long-acting opioids had a higher risk of long-term use than those initiating with short-acting drugs.ConclusionsEarly opioid prescribing patterns are associated with long-term use. While patient characteristics are important, clinicians have greater control over initial prescribing. Our findings may help minimize the risk of inadvertently initiating long-term opioid use.

Project description:ObjectivesTo examine the rates and predictors of long-term opioid therapy in older cancer survivors.DesignRetrospective cohort study.SettingTexas, United States.ParticipantsCancer survivors (5 years or more postcancer diagnosis) diagnosed from 1995 to 2008 and who were also Medicare Parts A, B, and D beneficiaries.MeasurementsWe used Medicare Part D event data to calculate the proportion of cancer survivors with a prolonged opioid prescription (90-day or more supply of opioids/year). Adjusted odds ratios were calculated to identify predictors of prolonged opioid prescribing. All analyses were repeated with a subcohort of opioid-naïve cancer survivors.ResultsThe rate of prolonged opioid therapy for cancer patients diagnosed in 2008 was 7.1% prior to cancer diagnosis; it rose to 9.8% within a year of cancer treatments, and to 13.3% at 5 years postdiagnosis. The rate at the sixth year varied by cancer sites: 19.4% in lung cancer and 9.6% in prostate cancer. Among opioid-naïve survivors, the rate increased from 1.4% to 7.1%, from 5 to 18 years postcancer diagnosis. Cancer survivors diagnosed in 2004 to 2008 had higher rates of opioid prescribing compared to those diagnosed in 1995 to 1998 and 1999 to 2003. Years since diagnosis, a later year of diagnosis, female sex, urban location, lung cancer diagnosis, disability as reason for Medicare entitlement, Medicaid eligibility, one or more comorbidity, and history of depression or drug abuse were predictors of prolonged opioid therapy. Among opioid-naïve cancer survivors, diagnosis in 2004 to 2008 was the strongest predictor, while a history of drug abuse was the strongest predictor for all the survivors.ConclusionThe rates of prolonged opioid prescribing for older cancer survivors remained high at 5 or more years after cancer diagnosis. Our findings have potential to inform the development of clinical guidelines and public policy to ensure safer and more effective pain treatment in older cancer survivors. J Am Geriatr Soc 67:945-952, 2019.

Project description:OBJECTIVE:This study examined opioid prescription initiation patterns and their association with short-term and long-term opioid use among opioid-naïve patients. DESIGN:This study was designed as a retrospective cohort study. SETTING AND PARTICIPANTS:In this study, we analysed the prescription databases of tertiary hospitals in Malaysia. This study included patients aged ≥18 years with at least one opioid prescription (buprenorphine, morphine, oxycodone, fentanyl, dihydrocodeine or tramadol) between 1 January 2011 and 31 December 2016. These patients had no opioid prescriptions in the 365 days prior, and were followed up for 365 days after the initial opioid prescription. MAIN OUTCOME MEASURES:The main outcome measures were the number of short-term (<90 days) and long-term opioid users (≥90 days), initial opioid prescription period and daily dose. RESULTS:There were 33 752 opioid-naïve patients who received opioid prescriptions (n=43 432 prescriptions) during the study period. Of these, 29 824 (88.36%) were short-term opioid users and 3928 (11.64%) were long-term opioid users. The majority of these short-term (99.09%) and long-term users (96.18%) received an initial daily opioid dose of <50 mg/day with a short-acting opioid formulation. Short-term opioid users were predominantly prescribed opioids for 3-7 days (59.06%) by the emergency department (ED, 60.56%), while long-term opioid users were primarily prescribed opioids for ≥7 days (91.85%) by non-ED hospital departments (91.8%). The adjusted model showed that the following were associated with long-term opioid use: increasing opioid daily doses, prescription period ≥7 days and long-acting opioids initiated by non-EDs. CONCLUSIONS:The majority of opioid-naïve patients in tertiary hospital settings in Malaysia were prescribed opioids for short-term use. The progression to long-term use among opioid-naïve patients was attributed to the prescription of higher opioid doses for a longer duration as well as long-acting opioids initiated by non-ED hospital departments.

Project description:BackgroundAlthough evidence from animal and human studies indicates opioid analgesics increase susceptibility to infections, it is unclear whether the risk varies by specific opioid. We compared the risk of serious infection among patients initiating long-acting opioid analgesics with and without previously reported immunosuppressive properties.MethodsWe conducted a retrospective cohort study of Tennessee Medicaid enrollees age ≥18 years initiating long-acting opioids (1995-2015). Hospitalizations for serious infection were identified using validated coding algorithms. We used multivariable Poisson regression models to calculate adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CI) to compare the infection risk among patients using long-acting opioids with known immunosuppressive properties (morphine, fentanyl, methadone) to the infection risk among patients using long-acting opioids without known immunosuppressive properties (oxycodone, oxymorphone, tramadol) accounting for demographics, opioid dose, comorbidities and pain conditions, medication use, frailty indicators, and healthcare encounter history using exposure propensity scores. We further compared users of individual long-acting opioids to long-acting morphine users (considered the prototypical immunosuppressive opioid).ResultsAmong the 61 240 patients initiating opioids with immunosuppressive properties and 22 811 patients initiating opioids without immunosuppressive properties, we identified 1906 serious infections. Nonimmunosuppressive opioid users had a lower rate of infections than immunosuppressive opioid users (aIRR:0.78 [CI: 0.66-0.91]). Among individual opioids, oxycodone users had a lower rate of infection than morphine users (aIRR:0.73 [CI: 0.60-0.89]). There were no significant differences in the infection risk between other opioids and morphine.ConclusionThe risk of serious infections among long-acting opioid users varies by opioid type. Providers should carefully consider the risk of serious infections when making pain management decisions.

Project description:Background: The College of Physicians and Surgeons of British Columbia introduced opioid prescribing standards and guidelines in mid-2016 in British Columbia. We evaluated impacts of the standards and guidelines on health outcomes. Methods: We conducted a longitudinal study with repeated measures using administrative data from December 2013 to March 2017. The study included BC patients with long-term use of prescription opioids. Those with a history of long-term care, palliative care or cancer were excluded. Patients were followed for a 12-month prepolicy period and 10-month postpolicy period and compared with historical controls. We estimated changes in level (sudden changes) and monthly trend (gradual changes) of rates of opioid overdose hospital admission, and secondary outcomes of all-cause hospital admission, all-cause emergency department visits, opioid overdose mortality and all-cause mortality. Results: The study included 68 113 patients in the main cohort and 68 429 historical controls. We did not find significant changes to opioid overdose hospital admissions in level (adjusted rate ratio [RR] 0.83, 95% confidence interval [CI] 0.45–1.54) or in trend (adjusted RR 1.00, 95% CI 0.91–1.10). All-cause hospital admissions declined in level but may have increased in trend, suggesting that a temporary decrease in hospital admissions may have occurred. We found no significant changes in all-cause emergency department visits, opioid overdose mortality or all-cause mortality. Interpretation: Among patients with a history of long-term prescription opioid use, the regulatory prescribing standards and guidelines were not associated with changes in opioid overdose hospital admissions, all-cause emergency department visits, opioid overdose mortality or all-cause mortality, or with a sustained reduction in all-cause hospital admissions, over a 10-month period after they were introduced. Future research should investigate whether opioid prescribing standards or guidelines are associated with use of nonopioid analgesic medications or nonpharmacologic treatments.

Project description:BackgroundThe College of Physicians and Surgeons of British Columbia introduced opioid prescribing standards and guidelines in mid-2016 in British Columbia. We evaluated impacts of the standards and guidelines on health outcomes.MethodsWe conducted a longitudinal study with repeated measures using administrative data from December 2013 to March 2017. The study included BC patients with long-term use of prescription opioids. Those with a history of long-term care, palliative care or cancer were excluded. Patients were followed for a 12-month prepolicy period and 10-month postpolicy period and compared with historical controls. We estimated changes in level (sudden changes) and monthly trend (gradual changes) of rates of opioid overdose hospital admission, and secondary outcomes of all-cause hospital admission, all-cause emergency department visits, opioid overdose mortality and all-cause mortality.ResultsThe study included 68 113 patients in the main cohort and 68 429 historical controls. We did not find significant changes to opioid overdose hospital admissions in level (adjusted rate ratio [RR] 0.83, 95% confidence interval [CI] 0.45-1.54) or in trend (adjusted RR 1.00, 95% CI 0.91-1.10). All-cause hospital admissions declined in level but may have increased in trend, suggesting that a temporary decrease in hospital admissions may have occurred. We found no significant changes in all-cause emergency department visits, opioid overdose mortality or all-cause mortality.InterpretationAmong patients with a history of long-term prescription opioid use, the regulatory prescribing standards and guidelines were not associated with changes in opioid overdose hospital admissions, all-cause emergency department visits, opioid overdose mortality or all-cause mortality, or with a sustained reduction in all-cause hospital admissions, over a 10-month period after they were introduced. Future research should investigate whether opioid prescribing standards or guidelines are associated with use of nonopioid analgesic medications or nonpharmacologic treatments.

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Dataset Information

Long term opioid use after burn injury: a retrospective cohort study.

Background

Methods

Results

Conclusions

Publications

Long term opioid use after burn injury: a retrospective cohort study.

Similar Datasets

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