Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States.
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, United States.
Front Public Health. 2024 Mar 26;12:1327934. doi: 10.3389/fpubh.2024.1327934. eCollection 2024.
Opioids are vital to pain management and sedation after trauma-related hospitalization. However, there are many confounding clinical, social, and environmental factors that exacerbate pain, post-injury care needs, and receipt of opioid prescriptions following orthopaedic trauma. This retrospective study sought to characterize differences in opioid prescribing and dosing in a national Medicaid eligible sample from 2010-2018. The study population included adults, discharged after orthopaedic trauma hospitalization, and receiving an opioid prescription within 30 days of discharge. Patients were identified using the International Classification of Diseases (ICD-9; ICD-10) codes for inpatient diagnosis and procedure. Filled opioid prescriptions were identified from National Drug Codes and converted to morphine milligram equivalents (MME). Opioid receipt and dosage (e.g., morphine milligram equivalents [MME]) were examined as the main outcomes using regressions and analyzed by year, sex, race/ethnicity, residence rurality-urbanicity, and geographic region. The study population consisted of 86,091 injured Medicaid-enrolled adults; 35.3% received an opioid prescription within 30 days of discharge. Male patients (OR = 1.12, 95% CI: 1.07-1.18) and those between 31-50 years of age (OR = 1.15, 95% CI: 1.08-1.22) were found to have increased odds ratio of receiving an opioid within 30 days of discharge, compared to female and younger patients, respectively. Patients with disabilities (OR = 0.75, 95% CI: 0.71-0.80), prolonged hospitalizations, and both Black (OR = 0.87, 95% CI: 0.83-0.92) and Hispanic patients (OR = 0.72, 95% CI: 0.66-0.77), relative to white patients, had lower odds ratio of receiving an opioid prescription following trauma. Additionally, Black and Hispanic patients received lower prescription doses compared to white patients. Individuals hospitalized in the Southeastern United States and those between the ages of 51-65 age group were found to be prescribed lower average daily MME. There were significant variations in opioid prescribing practices by race, sex, and region. National guidelines for use of opioids and other pain management interventions in adults after trauma hospitalization may help limit practice variation and reduce implicit bias and potential harms in outpatient opioid usage.
阿片类药物对于创伤相关住院后的疼痛管理和镇静至关重要。然而，有许多复杂的临床、社会和环境因素会加剧疼痛、受伤后的护理需求，并导致接受骨科创伤后的阿片类药物处方。这项回顾性研究旨在描述 2010-2018 年全国医疗补助合格样本中阿片类药物处方和剂量的差异。研究人群包括接受骨科创伤住院治疗后出院，并在出院后 30 天内开具阿片类药物处方的成年人。患者使用国际疾病分类（ICD-9；ICD-10）代码进行住院诊断和程序识别。通过国家药物代码识别已填写的阿片类药物处方，并将其转换为吗啡毫克当量（MME）。使用回归分析检查阿片类药物的使用和剂量（例如，吗啡毫克当量[MME]）作为主要结果，并按年份、性别、种族/族裔、居住地城乡分布和地理区域进行分析。研究人群包括 86091 名受伤的医疗补助登记成年人；35.3%的人在出院后 30 天内开具了阿片类药物处方。与女性和年轻患者相比，男性患者（比值比[OR] = 1.12，95%置信区间：1.07-1.18）和 31-50 岁的患者（OR = 1.15，95%置信区间：1.08-1.22）更有可能在出院后 30 天内接受阿片类药物治疗。与白人患者相比，有残疾（OR = 0.75，95%置信区间：0.71-0.80）、住院时间延长、黑人和西班牙裔患者（OR = 0.87，95%置信区间：0.83-0.92）和西班牙裔患者（OR = 0.72，95%置信区间：0.66-0.77）接受阿片类药物处方的可能性较小。此外，黑人和西班牙裔患者的处方剂量低于白人患者。与美国东南部住院的患者和 51-65 岁年龄组的患者相比，他们的平均每日 MME 剂量较低。阿片类药物处方的使用存在显著的种族、性别和地区差异。在创伤后住院的成年人中使用阿片类药物和其他疼痛管理干预措施的国家指南可能有助于限制实践差异，减少门诊阿片类药物使用中的潜在偏见和危害。
