Disclosures: Carlos A. Rodriguez, Jr., DO: No financial relationships or conflicts of interest

Objective: To determine predictors for increase in home opioid regimen status-post amputation.

Design: 1-Year Retrospective Case-Control Study Setting : Short-Term Acute Care Hospital Participants : 112 cases of amputation occurring between August 2018 and August 2019, with 56 cases (50%) demonstrating home opioid regimen increase at time of discharge, and 56 cases (50%) discharged with home opioid regimen effectively unchanged.

Interventions: Not applicable.

Main Outcome Measures: Patient demographics, chronic comorbidities, social history, hospital course timeline, and patient pain regimen – prior-to-admission, 24-hours pre-amputation, 24-hours post-amputation, and regimen at discharge.

Results: In comparing the case population, demonstrating opioid initiation or escalation of home opioid regimen at time of discharge (OIE), and the control population, discharged on a non-opioid pain regimen or resumed on PTA home opioid regimen (nonOIE), this study demonstrated a statistically significant difference in Tramadol prescribing (mg/d) in the 24-hour post-amputation period (M = 15.18, 95% CI [4.03, 26.32] in OIE, n=56; M = 2.23, 95% CI [-1.36, 5.82] in nonOIE, n=56). However, there was no statistically significant association with Tramadol prescribing (mg/d) in the PTA (M = 9.82, 95% CI [-5.04, 24.68] in OIE, n=56; M = 3.70, 95% CI [-3.56, 10.96] in nonOIE, n=54) or pre-amputation period (M = 25.89, 95% CI [1.81, 49.97] in OIE, n=56; M = 5.36, 95% CI [-2.00, 12.71] in nonOIE, n=56). Furthermore, no such statistically significant links were demonstrated with other opioid or non-opioid pharmacologic pain interventions in the PTA, pre-operative or post-operative periods. Conclusions: Overall, the inpatient hospital course and pain regimen were statistically equivalent among amputees with and without increase in home opioid regimen status-post amputation. However, increased dosing of an otherwise low-potency opioid like Tramadol in the 24-hour post-amputation period was associated with an increase in home opioid regimen at time of discharge, highlighting the potential for long-term downstream effects even with low-potency opioid prescribing in the early peri-amputation period.

Level of Evidence: Level III

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/major-predictors-for-home-opioid-initiation-or-escalation-in-the-peri-amputation-period-a-retrospective-case-control-study/