Trends in Opioid Discharge Prescribing for Trauma Patients With Fractured Ribs

High opioid prescribing at discharge was associated with increased opioid consumption during hospitalization and the number of rib fractures among trauma patients. These findings were published in the Journal of Surgical Research.

Patients (N=337) hospitalized for blunt or penetrating trauma resulting in rib fracture at the University of Colorado School of Medicine in 2019 were identified through the hospital’s Trauma Registry. No discharge prescription guidelines exist at the study site and choice of prescription and dosing were left to the discretion of the provider. Discharge opioid prescription patterns were evaluated on the basis of patient features. High prescribing was defined as 150 or more morphine milligram equivalents (MME).

The study cohort comprised 68.8% men, aged median 53 (IQR, 37-66) years, 79.5% were White, 97.3% had blunt trauma injury, the injury severity score (ISS) was 10 (IQR, 9-14), and number of rib fractures was 4 (IQR, 2-5).

Fewer than half of patients (44.2%) were admitted to the intensive care unit, 19.3% underwent surgery, the median length of hospital stay was 3 (IQR, 1-5) days, and 10.7% of patients were discharged to a rehabilitation facility.

Median total MME at admission was 112.5 and daily MME during hospitalization was 45.2.

At discharge, acetaminophen was prescribed to 63.2% of patients every 6 hours (72.5%) or every 6 hours as needed (26.5%) and ibuprofen was prescribed to 35.6% of patients every 6 hours (57.5%) or every 6 hours as needed (42.5%).

Most patients (74.5%) were prescribed opioids, 25.9% of which were prescribed without a nonopioid adjunct. The opioid prescriptions ranged from 37.5 to 1620 MME. Among patients who received a prescription for opioids, 87.6% filled their prescription and 38.2% were prescribed 1 or more refills.

Stratified by low and high MME discharge prescriptions, patients who received high MME dosing received surgery (P <.01), consumed more MME daily during hospitalization (P <.01), had more fractured ribs (P =.01), and had higher total MME at admission (P =.01).

In the multivariate analysis, 4 to 7 rib fractures (odds ratio [OR], 2.26; 95% CI, 1.36-3.74; P <.01) and daily MME during hospitalization (OR, 1.01; 95% CI, 1.01-1.02; P <.01) were significant predictors of MME prescription at discharge.

These data were sourced from a single center and trends may not be generalizable to other sites with differing prescribing protocols.

“Nonprotocolized approaches to discharge prescribing for patients with rib fractures may lead to unnecessary opioid prescriptions and nonevidenced based prescribing patterns, further potentiating the opioid crisis,” the study authors noted. “Ultimately, further prospective studies utilizing a standardized approach to discharge prescribing are needed to define best practices in pharmacologic pain management after hospitalization of patients with rib fractures.”

Reference

Gergen AK, Robinson C, Pieracci FM, et al. Assessment of discharge analgesic prescription patterns for hospitalized patients with rib fractures. J Surg Res. Published online March 22, 2022. doi:10.1016/j.jss.2022.02.022