Johnston Jackie P, LaPietra Alexis M, Elsawy Osama A, Wang Antai, Richards Lynette M, Yee Stephanie, Foran Lindsey A, Hlayhel Ahmad F, Fahey Ryan, Nerenberg Steven F
Department of Pharmacy, 6473St. Joseph's University Medical Center, Paterson, NJ, USA.
Department of Pharmacy Practice and Administration, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
Am Surg. 2023 Jan;89(1):113-119. doi: 10.1177/00031348211011105. Epub 2021 Apr 20.
Opioid analgesics remain mainstay of treatment for trauma-related pain despite growing concerns for opioid dependency or misuse. The purpose of this study was to evaluate opioid prescribing at hospital discharge after traumatic injury.
This is a single-center, retrospective analysis of patients ≥18 years of age admitted for ≥24 hours with a primary diagnosis of traumatic injury. Those with alcohol use disorder, polysubstance abuse, chronic opioid use, or in-hospital mortality were excluded. The primary outcome was the incidence of patients prescribed opioids at discharge. Secondary outcomes included percent of patients who received nonopioids, intensive care unit (ICU) admission, and hospital length of stay (LOS).
Of the 927 encounters, 471 were included. The mean age was 60 ± 23 years, and 62.0% were male. The majority were blunt trauma, and 49.9% were falls. Mean initial injury severity score (ISS) was 9 ± 7.2. Of the 70.4% of patients prescribed opioids, 39.4% were discharged on opioids. Age ≥30 years, ICU admission, ISS <9, or Charlson Comorbidity Index >1 was less likely to have opioids prescribed at discharge. Most received nonopioids (93.6%) and multimodal analgesia (84.3%). The median hospital and ICU LOS were 5 (3-9) and 2 (0-4) days, respectively.
Only 39.4% had opioids prescribed at discharge. Opioid-reductive strategies may decrease in-hospital and discharge opioid prescribing. While opioid analgesics remain a mainstay of trauma-associated pain management, institution-wide opioid-sparing strategies can further reduce discharge opioid prescribing after trauma.
尽管对阿片类药物依赖或滥用的担忧日益增加，但阿片类镇痛药仍然是创伤相关疼痛治疗的主要手段。本研究的目的是评估创伤性损伤后出院时阿片类药物的处方情况。
这是一项单中心回顾性分析，研究对象为年龄≥18岁、因创伤性损伤为主诊断入院≥24小时的患者。排除有酒精使用障碍、多种物质滥用、长期使用阿片类药物或住院期间死亡的患者。主要结局是出院时开具阿片类药物的患者发生率。次要结局包括接受非阿片类药物治疗的患者百分比、重症监护病房（ICU）入院情况以及住院时间（LOS）。
在927次就诊中，纳入了471例。平均年龄为60±23岁，男性占62.0%。大多数为钝性创伤，49.9%为跌倒所致。初始损伤严重程度评分（ISS）的平均值为9±7.2。在开具阿片类药物的患者中，70.4%的患者出院时仍在使用阿片类药物。年龄≥30岁、入住ICU、ISS<9或Charlson合并症指数>1的患者出院时开具阿片类药物的可能性较小。大多数患者接受了非阿片类药物（93.6%）和多模式镇痛（84.3%）。住院和ICU的中位住院时间分别为5（3 - 9）天和2（0 - 4）天。
只有
