Opioid Prescribing Practices After Isolated Pilon Fractures

Rodriguez-Buitrago, Andres; Attum, Basem; Enata, Nichelle; Evans, Adam; Obremskey, William T.; Sethi, Manish K.; Jahangir, A. Alex

doi:10.1053/j.jfas.2018.06.010

Cited by 7 publications

(36 citation statements)

References 18 publications

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“…Rodriguez-Buitrago et al 14 evaluated 72 patients treated surgically for isolated pilon fractures managed by orthopedic surgeons versus nonorthopedic prescribers. Average total MME prescribed in the orthopedic cohort was significantly greater than the nonorthopedic group (2,487 vs. 1,566 MMEs; p < 0.05).…”

Section: Resultsmentioning

confidence: 99%

“…1). Risk of bias and quality of evidence was assessed in the included 10 retrospective reviews [9][10][11][12][13][14][15][16]18,19 and 1 prospective observational review 17 (Table 1 and Table 2; Supplemental e-File 1, http://links.lww.com/ TA/C62). Reports from both trauma centers and national trauma registries were included.…”

Section: Study Selection and Assessment Of Quality Of Evidencementioning

confidence: 99%

“…[9][10][11][12]14,17,19 Seven articles did not report patient history regarding prior opioid use. 9,10,14,[18][19][20][21] Another limitation is the generalized underreporting of Injury Severity Score and Abbreviated Injury Scale score within our included studies, which inhibits our analysis of opioid prescribing practices and traumatic injury that could be a result of isolated injuries versus multiple injuries. Although eight of our selected studies have homogenous surgically managed populations, three have demonstrated heterogeneity.…”

Section: Limitationsmentioning

confidence: 99%

See 2 more Smart Citations

Postoperative opioid prescribing practices in US adult trauma patients: A systematic review

Rowe

Zagales

Fanfan

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Opioids have been proven effective in pain management, but overprescription can lead to addiction and abuse. Although current guidelines regarding opioid prescription for chronic and acute pain are available, they fail to address the use of opioids for pain management in traumatic injury patients who undergo operations. The primary objective of this study was to examine opioid prescribing practices for US adult trauma patients who require surgical management, based on prior history of opioid use, type of surgical practice, and age. METHODS:PubMed and Cochrane Journals were used to identify relevant articles between October 2010 and December 29, 2020. Our primary outcome was discrepancies of morphine milligram equivalents (MMEs) prescribed to trauma patients. Significance was defined as p < 0.05. RESULTS:Eleven studies on US trauma patients prescribed opioids were evaluated, creating a total of 30,249 patients stratified by prior opioid use, age, and race. Patterns seen among patients with prior opioid use include higher MMEs prescribed, lower likelihoods of opioid discontinuation, higher mortality rates, and higher complication rates. Orthopedic surgeons prescribed higher values of MMEs than nonorthopedic surgeons. CONCLUSION:Higher incidences of opioid prescriptions are seen with orthopedic trauma surgery and prior opioid use by the patient. We recommend further development of national protocol implementation for acute pain management for the US trauma population.

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Section: Resultsmentioning

confidence: 99%

Section: Study Selection and Assessment Of Quality Of Evidencementioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Postoperative opioid prescribing practices in US adult trauma patients: A systematic review

Rowe

Zagales

Fanfan

et al. 2021

J Trauma Acute Care Surg

View full text Add to dashboard Cite

show abstract

“…Similarly, in total hip arthroplasty patients, they found that orthopedic surgeons wrote 40% of opioid prescriptions from zero to three months postoperatively, which decreased to 14% from nine to 12 months postoperatively. Utilizing a state PDMP database, Rodriguez-Buitrago et al found that 39% of opioid prescriptions filled by pilon fracture repair patients within six months postoperatively were written by non-orthopedic providers [ 6 ]. These findings reflect the episodic role the orthopedic surgeon may have in the long-term health care of their postoperative patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, the actual sources of postoperative opioid prescriptions are rarely reported. Studies on opioid use in orthopedic surgery patients have found that a substantial number of postoperative opioid prescriptions are written by providers other than the orthopedic surgeons who had performed the surgical procedure [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Nonsurgical Providers Provide the Majority of Postoperative Opioid Prescriptions After Hand Surgery

Tadley¹,

Townsend²,

Bhatt³

et al. 2021

Cureus

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IntroductionThe increased use of Prescription Drug Monitoring Program (PDMP) websites has helped physicians to limit overlapping controlled substance prescriptions and help prevent opioid abuse. Many studies have investigated risk factors for prolonged opioid use after orthopedic surgery, but few studies have investigated who is prescribing opioids to postoperative patients. The purpose of this study is to investigate the types of medical providers prescribing opioids to hand surgery patients postoperatively. MethodsInstitutional Review Board approval was obtained prior to initiation of this study. An institutional database search was performed to identify all patients ≥18 years old that underwent a single hand surgery at our institution during a specified time period. Patients with more than one surgical procedure during this time were excluded to prevent potential crossover with opioid prescriptions for different surgical procedures. A search of the state PDMP website was performed to identify opioid prescriptions filled by hand surgery patients from six months preoperatively to 12 months postoperatively. Opioid prescribers were classified into several groups: 1) the patient's operating surgeon, 2) other orthopedic surgery providers, 3) general medicine providers (internal medicine, primary care, family medicine, and adult health providers), and 4) all other medical providers. ResultsThree hundred twenty-seven patients could be identified in the PDMP database who received an opioid prescription on the day of surgery. Of these, 108 (33.0%) filled a total of 341 additional opioid prescriptions postoperatively. Non-orthopedic providers prescribed 81.5% of all opioid prescriptions within 12 months postoperatively, with the patient's operating surgeon prescribing only 10% of all prescriptions. General medicine providers were the highest prescriber group at 28.7% of total postoperative opioid prescriptions. From six to 12 months postoperatively, the patient's operating surgeon prescribed only 4.9% of total opioid prescriptions filled. The patient's operating surgeon prescribed significantly smaller average opioid prescriptions in total morphine milligram equivalents compared to all other provider groups. ConclusionsSurgeons should be aware that their surgical patients may be receiving opioid prescriptions from a wide variety of medical providers postoperatively, and that these other providers may be prescribing larger prescriptions. The findings of this study emphasize the importance of collaboration across medical specialties to mitigate the risks of prolonged opioid use after hand surgery.

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Does the type of lower extremity fracture affect long-term opioid usage? A meta-analysis

Otwell,

Stambough,

Cherney

et al. 2024

Arch Orthop Trauma Surg

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Opioid Prescribing Practices After Isolated Pilon Fractures

Cited by 7 publications

References 18 publications

Postoperative opioid prescribing practices in US adult trauma patients: A systematic review

Postoperative opioid prescribing practices in US adult trauma patients: A systematic review

Nonsurgical Providers Provide the Majority of Postoperative Opioid Prescriptions After Hand Surgery

Does the type of lower extremity fracture affect long-term opioid usage? A meta-analysis

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