Williamson Frances, Proper Melanie, Shibl Rania, Cramb Susanna, McCreanor Victoria, Warren Jacelle, Cameron Cate
Trauma Service, Metro North Health, Royal Brisbane & Women's Hospital, Herston, QLD, Australia.
Faculty of Medicine, The University of Queensland, Herston, QLD, Australia.
Br J Pain. 2024 Nov 20:20494637241300264. doi: 10.1177/20494637241300264.
Pain from rib fractures often requires inpatient management with opioid medication. The need for ongoing opioid prescriptions following hospital discharge is poorly understood. Harms associated with long-term opioid use are generally accepted. However, a deeper understanding of current prescribing patterns in this population at-risk is required.
A retrospective cohort of adult patients hospitalised in Queensland, Australia between 2014 and 2015 with rib fractures (ICD-10-AM: S22.3, S22.4, S22.5), was obtained from the Community Opioid Dispensing after Injury (CODI) study, which includes person-linked hospitalisation, mortality and community opioid dispensing data. Data were extracted 90-days prior to the index-hospitalisation and 720-days after discharge. Factors associated with long-duration (>90 days cumulatively) and increased end-dose were examined using multivariable logistic regressions, odds ratios (OR), and 95% confidence intervals (95% CI).
In total, 4306 patients met the inclusion criteria, and 58.8% had opioids dispensed in the community within 30 days of hospital discharge. 23.6% had long-duration dispensing and 13.7% increased opioid end-doses. Pre-injury opioid use was most associated with long-duration (OR = 12.00, 95% CI 8.99-16.01) and increased end-dose (OR = 9.00, 95% CI 6.75-12.00). Females and older persons had higher odds of long-duration dispensing (Females OR = 1.75, 95% CI 1.38-2.22; Age 65+ OR = 1.86, 95% CI 1.32-2.61). Injury severity and presence of concurrent injuries were not statistically significantly associated with duration or dose ( > .05). Subsequent hospitalisations and death during the follow-up period had statistically significant associations with long-duration and increased end-dose ( < .001).
Opiate prescribing following rib fractures is prolonged in older, and female patients, beyond the traditionally reported recovery time frames requiring analgesia. Previous opioid use (without dependence) is associated with long-duration opioid use and increased end-dose in rib fracture patients. These results support the need for a collaborative health system approach and individualised strategies for high-risk patients with rib fractures to reduce long-term opiate use.
Level III, Prognostic/Epidemiological.
肋骨骨折引起的疼痛通常需要住院使用阿片类药物治疗。对于出院后持续开具阿片类药物处方的必要性，人们了解甚少。长期使用阿片类药物的危害已得到普遍认可。然而，需要更深入地了解这一高危人群当前的处方模式。
从“受伤后社区阿片类药物配药（CODI）”研究中获取了2014年至2015年在澳大利亚昆士兰州住院的成年肋骨骨折患者（国际疾病分类第十版澳大利亚修订本：S22.3、S22.4、S22.5）的回顾性队列，该研究包括与个人相关的住院、死亡率和社区阿片类药物配药数据。在索引住院前90天和出院后720天提取数据。使用多变量逻辑回归、比值比（OR）和95%置信区间（95%CI）检查与长期（累计>90天）和最终剂量增加相关的因素。
共有4306名患者符合纳入标准，58.8%的患者在出院后30天内在社区获得了阿片类药物配药。23.6%的患者有长期配药，13.7%的患者阿片类药物最终剂量增加。受伤前使用阿片类药物与长期配药（OR = 12.00，95%CI 8.99 - 16.01）和最终剂量增加（OR = 9.00，95%CI 6.75 - 12.00）最为相关。女性和老年人长期配药的几率更高（女性OR = 1.75，95%CI 1.38 - 2.22；65岁及以上OR = 1.86，95%CI 1.32 - 2.61）。损伤严重程度和并发损伤的存在与配药持续时间或剂量无统计学显著相关性（P>.05）。随访期间的后续住院和死亡与长期配药和最终剂量增加有统计学显著相关性（P<.001）。
肋骨骨折后阿片类药物的处方在老年女性患者中延长，超出了传统报道的需要镇痛的恢复时间框架。既往使用阿片类药物（无依赖）与肋骨骨折患者长期使用阿片类药物和最终剂量增加有关。这些结果支持需要采取协作性卫生系统方法和针对肋骨骨折高危患者的个体化策略，以减少长期阿片类药物的使用。
三级，预后/流行病学。
