Factors influencing which patients need opioid analgesia after hospital discharge with rib fractures are poorly understood. Harms associated with long-term opioid use are generally accepted, leading to the need for a deeper understanding of current prescribing patterns in at-risk populations.
A retrospective cohort of adult patients hospitalised in Queensland between 2014-2015 with rib fractures, was obtained from the Community Opioid Dispensing after Injury (CODI) study. 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).
4,306 patients were included, 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>0.05). Subsequent hospitalisations and death during the follow-up period had statistically significant associations with long-duration and increased end-dose (p<0.001).
Opioid prescribing following rib fractures is prolonged in older, and female patients, beyond traditionally reported recovery time frames requiring analgesia. Previous opioid use (without dependence) is associated with long-duration and increased end-dose. A collaborative health system approach is needed with individualised strategies for high-risk patients to reduce long-term opioid use.