{"title":"肋骨骨折伤后的社区阿片类药物分配：CODI 研究。","authors":"Frances Williamson, Melanie Proper, Rania Shibl, Susanna Cramb, Victoria McCreanor, Jacelle Warren, Cate Cameron","doi":"10.1177/20494637241300264","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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 (<i>p</i> > .05). Subsequent hospitalisations and death during the follow-up period had statistically significant associations with long-duration and increased end-dose (<i>p</i> < .001).</p><p><strong>Conclusion: </strong>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.</p><p><strong>Level of evidence: </strong>Level III, Prognostic/Epidemiological.</p>","PeriodicalId":46585,"journal":{"name":"British Journal of Pain","volume":" ","pages":"20494637241300264"},"PeriodicalIF":1.3000,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577336/pdf/","citationCount":"0","resultStr":"{\"title\":\"Community opioid dispensing after rib fracture injuries: CODI study.\",\"authors\":\"Frances Williamson, Melanie Proper, Rania Shibl, Susanna Cramb, Victoria McCreanor, Jacelle Warren, Cate Cameron\",\"doi\":\"10.1177/20494637241300264\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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).</p><p><strong>Results: </strong>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 (<i>p</i> > .05). Subsequent hospitalisations and death during the follow-up period had statistically significant associations with long-duration and increased end-dose (<i>p</i> < .001).</p><p><strong>Conclusion: </strong>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.</p><p><strong>Level of evidence: </strong>Level III, Prognostic/Epidemiological.</p>\",\"PeriodicalId\":46585,\"journal\":{\"name\":\"British Journal of Pain\",\"volume\":\" \",\"pages\":\"20494637241300264\"},\"PeriodicalIF\":1.3000,\"publicationDate\":\"2024-11-20\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11577336/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"British Journal of Pain\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/20494637241300264\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"British Journal of Pain","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/20494637241300264","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景：肋骨骨折引起的疼痛通常需要住院患者使用阿片类药物进行治疗。人们对出院后是否需要继续处方阿片类药物知之甚少。长期使用阿片类药物的危害已被普遍接受。然而，我们需要更深入地了解这一高危人群目前的处方模式：从 "受伤后社区阿片类药物配药"（CODI）研究中获得了 2014 年至 2015 年期间在澳大利亚昆士兰州因肋骨骨折（ICD-10-AM：S22.3、S22.4、S22.5）住院的成年患者的回顾性队列，其中包括与个人相关的住院、死亡和社区阿片类药物配药数据。数据提取时间为指数住院前 90 天和出院后 720 天。使用多变量逻辑回归、几率比（OR）和 95% 置信区间（95% CI）研究了与长期用药（累计超过 90 天）和最终用药量增加相关的因素：共有 4306 名患者符合纳入标准，58.8% 的患者在出院后 30 天内在社区配发了阿片类药物。23.6%的患者长期使用阿片类药物，13.7%的患者增加了阿片类药物的最终用量。受伤前使用阿片类药物与长期使用（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）关系最大。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 岁以上 OR = 1.86，95% CI 1.32-2.61）。受伤严重程度和是否同时受伤与持续时间或剂量无明显统计学关联（P > .05）。随访期间的后续住院和死亡与持续时间长和最终剂量增加有统计学意义（p < .001）：结论：年龄较大的女性患者在肋骨骨折后使用阿片类药物的时间较长，超过了传统报告的需要镇痛的恢复时间。曾使用阿片类药物（无依赖性）与肋骨骨折患者长期使用阿片类药物和最终用量增加有关。这些结果支持了对肋骨骨折高危患者采取医疗系统协作方法和个性化策略的必要性，以减少阿片类药物的长期使用：III级，预后/流行病学。
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 (p > .05). Subsequent hospitalisations and death during the follow-up period had statistically significant associations with long-duration and increased end-dose (p < .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.
期刊介绍：
British Journal of Pain is a peer-reviewed quarterly British journal with an international multidisciplinary Editorial Board. The journal publishes original research and reviews on all major aspects of pain and pain management. Reviews reflect the body of evidence of the topic and are suitable for a multidisciplinary readership. Where empirical evidence is lacking, the reviews reflect the generally held opinions of experts in the field. The Journal has broadened its scope and has become a forum for publishing primary research together with brief reports related to pain and pain interventions. Submissions from all over the world have been published and are welcome. Official journal of the British Pain Society.
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