Investigating patterns of long-term opioid usage in 11,771 trauma survivors with up to 6 years follow-up in Denmark

BACKGROUND – Opioids have a well-known capacity to induce long-term dependency with related increased morbidity and mortality. Usage patterns following traumatic injury are, however, not well studied. We investigated long-term opioid usage patterns for trauma survivors, hypothesizing that postdischarge sustained opioid use was prevalent for both preinjury opioid naïve and opioid users. We furthermore hypothesized that postdischarge opioid use would be associated with overall survival (OS) and hospital contacts. METHODS – Electronic health records from 11, 771 trauma patients surviving to discharge from the Capital and Zealand regions in Denmark from January 1, 2017, to July 30, 2023, were merged with prescription medication registry data to uncover preadmission and postadmission opioid use. Prescription medication data were available from January 1, 1994, to September 30, 2023, allowing for between 2 months and 6 years follow-up. Data were analyzed using descriptive statistics and OS analyses using regression corrected for age, sex, Injury Severity Score, Elixhauser comorbidity score, and pretrauma opioid use. RESULTS – Of all trauma survivors, 25.8% had prescription opioid use following discharge. This pattern was more frequent in patients with pretrauma opioid use (74.3%) versus pretrauma opioid naïve patients (21.9%). Of preinjury opioid naïve patients using prescription opioids postdischarge, 33.4% still maintained usage at 1-year follow-up, dropping to 13.8% at 3 years follow-up. Cox regression corrected for confounders could not identify an association between postdischarge opioid use and OS (hazard ratio, 1.08, p = 0.44). Postdischarge opioid use was associated with risk of 30-day readmission (hazard ratio, 1.59), as well as overall hospital admissions and outpatient contacts. CONCLUSION – For trauma survivors, postdischarge long-term opioid use is prevalent in trauma survivors, highlighting the potential for close follow-up and opioid tapering plans to optimize long-term outcomes. Postdischarge opioid use could not be associated with OS but was associated with increased healthcare resource utilization. LEVEL OF EVIDENCE – Retrospective; Level III.