Jackie Johnston, BCPS, PharmD
Clinical Assistant Professor
Rutgers Ernest Mario School of Pharmacy
Piscataway, New Jersey
Disclosure information not submitted.
Steven Nerenberg, PharmD
Emergency Medicine Clinical Pharmacist / Clinical Assistant Professor
St. Joseph's University Medical Center, United States
Disclosure information not submitted.
Alexis LaPietra, DO, FACEP
Chief, Pain Management/Addiction Medicine
St. Joseph's University Medical Center, United States
Disclosure information not submitted.
Antai Wang, PhD
Associate Professor
New Jersey Institute of Technology, United States
Disclosure information not submitted.
Caitlin Kulig, PharmD
Assistant Clinical Professor/Cardiology Clinical Pharmacist
n/a
Piscataway, NJ, United States
Disclosure information not submitted.
Lindsey Foran, DO
Surgery Resident
St. Joseph's University Medical Center, United States
Disclosure information not submitted.
Ahmad Hlayhel, MD
Surgery Resident
St. Joseph's University Medical Center, United States
Disclosure information not submitted.
James Yang, DO
Surgery Resident
St. Joseph's University Medical Center, United States
Disclosure information not submitted.
Dinesh Parmar, MD
Anesthesiology Resident
St. Joseph's University Medical Center, United States
Disclosure information not submitted.
Osama Elsawy, DO
Trauma Surgeon
St. Joseph's University Medical Center, United States
Disclosure information not submitted.
Title: Effect of Alternatives to Opiates Program on Discharge Opioid Prescribing in Trauma Patients
Introduction: Opioid overdose deaths increased over two decades, with the incidence accelerated further during the COVID-19 pandemic. While opioids remain mainstay for trauma-related pain management, organizations are focused on reducing use. This study aimed to determine if a hospital-wide Alternatives to Opiates (ALTO) program reduced opioid prescribing at discharge after trauma.
Methods: A single-center, retrospective analysis of patients >18 years old admitted for >24 hours with primary diagnosis of traumatic injury between August 1, 2018 - October 31, 2019 was performed. Admissions before July 1, 2019, represent the control group, whereas admissions on/after represent the ALTO group. Patients with alcohol or polysubstance abuse, chronic opioid use, or in-hospital mortality were excluded. The primary outcome was incidence of opioid prescribing at discharge. Secondary outcomes were percent with in-hospital non-opioid and multimodal analgesia, and hospital and intensive care unit (ICU) length of stay (LOS). A sample size of 129 patients was needed to observe a 30% reduction in primary outcome and maintain 80% power to detect a statistically significant difference using alpha < 0.05.
Results: A total of 703 patients were included, 471 in the control and 232 in the ALTO groups. Mean age was 59±22 years and 58.7% were male. Mean initial Injury Severity Score (ISS) was 9.1±7.7 and Charlson Comorbidity Index (CCI) was 2.7±2.7. In-hospital opioid prescribing was higher (70.4% vs. 87.5%, p< 0.0001), and opioid discontinuation at hospital discharge occurred less frequently (60.5% vs. 56.2%, p=0.1237) after ALTO implementation. Surgical intervention, lack of ICU admission, ISS >9 and CCI <1 was associated with lower incidence of opioid discontinuation at discharge in both groups. Most patients received non-opioid (93.6 vs. 98.7%, p=0.0051) and multimodal analgesia (84.3% vs. 87.5%, p=0.3083) during hospitalization. Median hospital LOS [5(3-9) vs. 4(3-7), p=0.3427] and ICU LOS [2(0-4) vs. 3(2-5), p=0.3461] were similar.
Conclusions: Opioids remain mainstay for trauma-related pain management. In our study, ALTO was not associated with a reduction in in-hospital opioid prescribing or at discharge. Identification and implementation of strategies to further reduce opioid prescribing at discharge in trauma patients are needed.