Patterns of Use and Factors Associated with Sustained Prescription Opioid Use After Necrotizing Soft Tissue Infections (NSTIs)

Barbara Okafor, BS, MBA
Department of Surgery
Division of Trauma, Burn and Surgical Critical Care
Poster Overview

Necrotizing soft-tissue infections (NSTIs) are rare and serious bacterial infections that destroy the tissue under the skin. They lead to surgical emergencies that involve high rates of complications and deaths. These infections can also cause pain after hospital discharge. Prior research has shown that continued opioid use at 1-year after Emergency General Surgery (EGS) is approximately 1.7%. However, there is little data on prescribing-patterns seen at 1- year in NSTI populations. Our aim is to study sustained opioid prescription rates in NSTI patients.

This retrospective study included NSTI patients from the TRICARE insurance database between 2007 to 2015. We collected data, including: age, gender, comorbidities, rank, marital status, beneficiary category, region, history of anxiety/depression, length of stay and opioid prescription for pain. Risk-adjusted analysis was performed to highlight the likelihood of sustained opioid use. Analysis revealed that older age, married status, previous diagnosis of anxiety, comorbidities and length of stay were associated with decreased likelihood of opioid discontinuation; while being retired and in the Midwest were associated with increased likelihood. The rate of opioid prescription at 1-year in NSTI patients was higher than the rate in EGS patients. Further studies need to focus on improving pain management strategies for high- risk patients.

Scientific Abstract

Background: Prolonged opioid use is a major concern when treating pain after surgery. Data has shown that 1.7% of patients are still using opioids 1-year after Emergency General Surgery (EGS). However, prolonged opioid use has not been studied in patients with Necrotizing Soft Tissue Infections (NSTIs). Our aim was to study the patterns of use and factors associated with prolonged opioid use in NSTI patients at discharge.

 

Methods: The 2007-2015 TRICARE insurance database was queried for NSTI patients between 18-64 years. Patient demographics, clinical characteristics and opioid prescriptions were collected. Risk-adjusted analysis was used to determine the predictors of opioid discontinuation.

 

Results: Out of 2,890 patients, 1,083 received an opioid prescription at discharge. 30% filled ≥1 opioid prescription after discharge, 10.5% continued opioid use at 3-month, 6.6% at 6-month, and 4.1% at 1-year. Older age, married status, previous diagnosis of anxiety, comorbidities and length of stay were associated with decreased likelihood of opioid discontinuation; being retired and in the Midwest were associated with increased likelihood.

 

Conclusion: Opioid use was higher 1-year after discharge in NSTI patients compared to the reported rate for EGS. Further research needs to focus on developing guidelines to adequately prescribe and discontinue opioids with NSTI patients.

Clinical Implications
Opioids are prescribed for pain seen in high-risk patients after discharge. This research can help surgeons focus on developing strategies and guidelines to adequately prescribe and discontinue opioids in the NSTI population.
Research Areas
Authors
Barbara U. Okafor MBA, Manuel Castillo-Angeles MD, MPH, Stephanie Nitzschke MD, Tracey Koelhmoos PhD, Zara Cooper MD, Ali Salim MD, Reza Askari MD
Principal Investigator
Reza Askari, MD

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