Smith Sophia M, Adams Rachel, Ha Emily, Chan Wang Pong, Jenkins Kendall, Michael Cara, Saillant Noelle N, Franks Jeffrey A, Sanchez Sabrina E
From the Department of Surgery, Boston Medical Center, Boston, MA (Smith, Adams, Saillant, Franks, Sanchez).
Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, Boston, MA (Smith, Ha, Chan, Jenkins, Michael, Saillant, Franks, Sanchez).
J Am Coll Surg. 2025 Jun 1;240(6):915-925. doi: 10.1097/XCS.0000000000001353. Epub 2025 May 14.
Opioid prescribing is understudied in trauma patients, where disadvantaged communities are overrepresented. In this study, we evaluated disparities in opioid administration after trauma.
We conducted a retrospective cohort study of injured adults at a Level I trauma center, 2018 to 2021. Opioids were quantified in milligram morphine equivalents (MMEs). Primary outcomes were receipt of opioids inpatient and at discharge, MMEs per hospital day, and, for patients prescribed opioids at discharge, MMEs and discharge pain control days. Multivariable logistic regression identified factors associated with overall receipt of opioids after injury, general linear modeling identified factors associated with MMEs received inpatient and at discharge, and negative binomial regression evaluated pain control days prescribed at discharge.
Of 3,032 patients, 2,514 (82.92%) required opioids as an inpatient and 1,803 (71.72%) still required opioids the day of discharge. Of these, 1,310 (72.66%) were discharged with opioids. Black (β -24.94, 95% CI -37.25 to -12.62, p < 0.001) and Hispanic (β -21.96, 95% CI -39.21 to -4.71, p = 0.01) patients received lower MMEs while inpatient. Factors associated with lower odds of discharge with opioids included non-English language (odds ratio [OR] 0.56, 95% CI 0.38 to 0.82, p = 0.003), substance use disorder (OR 0.69, 95% CI 0.49 to 0.97, p = 0.03), neuropsychiatric comorbidity (OR 0.58, 95% CI 0.39 to 0.87, p = 0.008), and violent injury (OR 0.61, 95% CI 0.45 to 0.85, p = 0.003). On discharge, Black individuals (β -130.71, 95% CI -251.26 to -10.17, p = 0.03) received lower MMEs and patients with substance use disorder (incidence rate ratio 0.65, 95% CI 0.53 to 0.80, p < 0.001) received fewer pain control days.
Trauma patients experienced disparities in opioid prescribing throughout hospitalization. Lower opioid doses were administered to non-White patients, while language, mental health comorbidity, and mechanism influenced discharge opioid prescriptions.
在创伤患者中，阿片类药物的处方情况研究较少，而弱势群体在创伤患者中占比过高。在本研究中，我们评估了创伤后阿片类药物使用的差异。
我们对2018年至2021年在一级创伤中心受伤的成年人进行了一项回顾性队列研究。阿片类药物以毫克吗啡当量（MMEs）进行量化。主要结局包括住院期间和出院时接受阿片类药物的情况、每天的MMEs，以及对于出院时开具阿片类药物的患者，MMEs和出院时的疼痛控制天数。多变量逻辑回归确定了受伤后总体接受阿片类药物相关的因素，一般线性模型确定了住院期间和出院时接受MMEs相关的因素，负二项回归评估了出院时开具的疼痛控制天数。
在3032名患者中，2514名（82.92%）住院期间需要阿片类药物，1803名（71.72%）出院当天仍需要阿片类药物。其中，1310名（72.66%）出院时带阿片类药物。黑人（β -24.94，95%可信区间 -37.25至 -12.62，p < 0.001）和西班牙裔（β -21.96，95%可信区间 -39.21至 -4.71，p = 0.01）患者住院期间接受的MMEs较低。出院时带阿片类药物几率较低的相关因素包括非英语语言（比值比[OR] 0.56，95%可信区间0.38至0.82，p = 0.003）、物质使用障碍（OR 0.69，95%可信区间0.49至0.97，p = 0.03）、神经精神合并症（OR 0.58，95%可信区间0.39至0.87，p = 0.008）和暴力损伤（OR 0.61，95%可信区间0.45至0.85，p = 0.003）。出院时，黑人个体（β -130.71，95%可信区间 -251.26至 -10.17，p = 0.03）接受的MMEs较低，物质使用障碍患者（发病率比0.65，95%可信区间0.53至0.80，p < 0.001）接受的疼痛控制天数较少。
创伤患者在整个住院期间阿片类药物处方存在差异。非白人患者接受的阿片类药物剂量较低，而语言、心理健康合并症和受伤机制影响出院时的阿片类药物处方。
