Prospective Evaluation of Utilization Patterns and Prescribing Guidelines of Opioid Consumption Following Orthopedic Foot and Ankle Surgery

Saini, Sundeep; McDonald, Elizabeth; Shakked, Rachel; Nicholson, Kristen; Rogero, Ryan; Chapter, Megan C.; Winters, Brian S.; Pedowitz, David I.; Raikin, Steven M.; Daniel, Joseph N.

doi:10.1177/1071100718790243

Cited by 59 publications

(78 citation statements)

References 37 publications

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“…Various studies have examined factors that might influence the amount of narcotic pain medication a patient might require after foot and ankle surgery. Saini et al 14 saw that increasing age was associated with less narcotic use. Mulligan et al 12 showed that a history of chronic pain, mood disorders, tobacco use, and preoperative narcotic use were all associated with increased postoperative narcotic use.…”

Section: Discussionmentioning

confidence: 99%

“…11 Although many types of orthopedic procedures necessitate opioid prescriptions for pain management, foot and ankle surgeries are especially associated with elevated levels of opioid prescriptions. 10,14 Increased control of opioid prescription has been attempted on both clinical and regulatory levels. In North Carolina, the Strengthen Opioid Misuse Prevention Act of 2017 (STOP Act) went into effect on January 1, 2018, augmenting the efforts of established federal opioid misuse prevention programs like the Prescription Drug Monitoring Program.…”

Section: Introductionmentioning

confidence: 99%

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Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

Hussaini

Wang

Luo

et al. 2019

Foot & Ankle Orthopaedics

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Background: In North Carolina, the Strengthen Opioid Misuse Prevention Act of 2017 (STOP Act) went into effect on January 1, 2018, intending to increase oversight over opioid prescriptions. This study compares postoperative narcotic prescription practices following operative fixation of ankle fractures before and after the STOP Act. Methods: This study was a retrospective review of patients 18 years and older who underwent operative fixation of ankle fractures between January 1 and June 30, 2017 (before STOP Act), and between January 1 and June 30, 2018 (after STOP Act). Variables of interest included demographics, amount of opioids prescribed postoperatively, number of prescription refills, and number of pain-related calls or visits to the emergency department (ED) or clinic after surgery. This study assessed 71 patients in the Pre group and 47 patients in the Post group. Results: There was a statistically significant decrease in the average number of postoperative narcotic pills prescribed after the STOP Act (52.7 vs 76.2, P < .001). There was also a statistically significant decrease in the average number of prescription refills (0.6 vs 1.0, P = .037). There were no significant changes in pain-related clinic calls (35.2% Pre vs 34.0% Post, P = .896), pain-related clinic visits ahead of schedule (4.2% Pre vs 6.4% Post, P = .681), or pain-related ED visits (2.8% Pre vs 10.6% Post, P = .113). Conclusion: In the postoperative period after operative fixation of ankle fractures, the volume of narcotic prescriptions decreased after the new legislation, without an associated strain on medical resources. Level of Evidence: Level III, therapeutic, comparative study.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

Hussaini

Wang

Luo

et al. 2019

Foot & Ankle Orthopaedics

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“…8 Although several studies have examined opioid usage following foot and ankle procedures, there is a paucity of data on risk factors for prolonged opioid usage following TAA. A recent prospective cohort study by Saini et al 17 identified 4 independent factors associated with increased opioid consumption following outpatient foot and ankle procedures: regional block anesthesia, age <60 years, preoperative visual analog scale score >6, hindfoot procedures, and bony procedures. In the same study, there was a trend toward patients who self-reported anxiety consuming greater opioids; however, it did not achieve statistical significance.…”

Section: Discussionmentioning

confidence: 99%

“…In the same study, there was a trend toward patients who self-reported anxiety consuming greater opioids; however, it did not achieve statistical significance. 17 Merrill et al 12 reported that patients undergoing ankle/hindfoot procedures consumed a significantly higher number of long-acting opioids, such as MS Contin or Oxycontin (Purdue Pharma), when compared to forefoot procedures. They found no difference in bony vs soft tissue procedures or in use of short-acting opioids.…”

Section: Discussionmentioning

confidence: 99%

Association of Preoperative Opioid Use and Prolonged Postoperative Opioid Use Following Total Ankle Arthroplasty

DeMik

Cychosz

Bedard

et al. 2020

Foot & Ankle Orthopaedics

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Background: Perioperative opioid consumption has received a great deal of recent attention. However, perioperative opioid utilization in the total ankle arthroplasty (TAA) population has not been well studied. We sought to identify factors associated with postoperative opioid use following TAA. Methods: The PearlDiver Research Program was used to query the Humana, Inc, administrative claims database from 2007 to 2017 for patients undergoing TAA. Additional variables of interest were identified using ICD-9 and ICD-10 codes. Preoperative opioid use was defined as having filled an opioid prescription in the 3 months before TAA. Prescription opioid claims data were tracked for 12 months postoperatively. Risk ratios (RRs) were calculated and multivariate analysis was performed at 3, 6, and 12 months postoperatively. Results: A total of 544 patients who underwent TAA were identified, with 180 (33.1%) filling an opioid prescription preoperatively. Those filling prescriptions preoperatively had a significantly greater risk for postoperative opioid use compared to those not taking opioids (RR: 4.36 [95% confidence interval (CI): 2.80-6.80] at 12 months). Anxiety or depression (RR: 2.27 [1.44-3.59]), low back pain (LBP) (RR: 2.27 [1.50-3.42]), and fibromyalgia (RR: 2.15 [1.42-3.28]) were also found to increase the risk of taking opioids at 12 months postoperatively. Multivariate analysis found preoperative opioid use to be the strongest predictor of postoperative opioid use. Conclusions: Nearly one-third of patients filled an opioid prescription within 3 months of TAA, and filling a prescription preoperatively was the strongest factor associated with postoperative opioid use. Fibromyalgia, depression or anxiety, and LBP were also associated with an increased likelihood of postoperative opioid use. Level of Evidence: Level III, retrospective cohort study.

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“…Prescription opioids are commonly used to manage postoperative pain (Berterame et al, 2016; Morris & Mir, 2015; Neuman, Bateman, & Wunsch, 2019; Seymour, Ring, Higgins, & Hsu, 2017). However, recent studies have shown that postoperative discharge opioid prescriptions are frequently variable and more than what patients actually require for effective pain relief (Bicket, Long, Pronovost, Alexander, & Wu, 2017; Saini et al, 2018). Overprescription of opioids may lead to heightened risks of adverse events, opioid misuse, opioid dependence, diversion for nonmedical uses, overdose, and death (Morris & Mir, 2015; Seymour et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with discharge opioid prescription after hip fracture fixation

Fandino

Bhashyam

Harris

et al. 2020

Musculoskeletal Care

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Objective Opioid prescribing after hip fracture fixation is variable, but the factors that drive this prescribing variation are not well‐described. The purpose of this study was to determine independent factors associated with increased opioid prescription upon discharge after hip fracture fixation. Methods A retrospective cohort study of 296 adult patients who underwent hip fracture fixation between January 2016 and December 2017 at two Level I trauma centers were included in our study. The primary outcome measurement was opioid prescription at discharge in morphine milligram equivalents (MME). Bivariate analysis was used to screen for factors, and multivariable regression analysis was used to identify independent factors associated with opioid prescription upon discharge from the hospital. Results Discharge opioid prescription amounts were available for 280 out of 296 patients (95%). The mean (±standard deviation) discharge opioid prescription was 212 (±319) MME. Multivariable regression analysis showed that younger age (p = 0.004), diabetes mellitus (p = 0.02), smoking (p < 0.001), treatment at hospital #2 (p < 0.001), and weekend discharge (p = 0.03) were associated with increased opioid prescription at discharge. Conclusions Increased opioid prescribing after hip fracture fixation is associated with patient‐ and system‐related factors. Prescriber education programs, prescription guidelines, and safe handoff practices that focus on these factors may help to decrease prescription variability and opioid overprescription across institutions.

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Prospective Evaluation of Utilization Patterns and Prescribing Guidelines of Opioid Consumption Following Orthopedic Foot and Ankle Surgery

Abstract: Level II, prospective observational cohort study.

Cited by 59 publications

References 37 publications

Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

Effect of the Strengthening Opioid Misuse Prevention (STOP) Act on Opioid Prescription Practices After Ankle Fracture Fixation

Association of Preoperative Opioid Use and Prolonged Postoperative Opioid Use Following Total Ankle Arthroplasty

Factors associated with discharge opioid prescription after hip fracture fixation

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