Community opioid dispensing after rib fracture injuries: CODI study.

Background: 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.

Methods: 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).

Results: 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).

Conclusion: 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 Of Evidence: Level III, Prognostic/Epidemiological.