Risk Factors for Continued Opioid Use One to Two Months After Surgery for Musculoskeletal Trauma

Helmerhorst, Gijs T.T.; Vranceanu, Ana‐Maria; Vrahas, Mark; Smith, M.Lorraine; Ring, David

doi:10.2106/jbjs.l.01406

Cited by 233 publications

(200 citation statements)

References 39 publications

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“…Although functional outcomes were not assessed in our study, the greater need for posthospitalization care could further be interpreted as a less rapid return of independent functional mobility in this patient population [38,39]. It is possible that lower levels of selfefficacy for managing pain-greater pain catastrophizingand resilience in maintaining function among chronic opioid users contributed to the higher rate of posthospitalization care observed in our study [26,47], and also may partly explain why these patients tend to have worse functional outcomes after orthopaedic procedures [31,32,42,57].…”

Section: Discussionmentioning

confidence: 73%

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

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309

176

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Background Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting. Questions/purposes We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.

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Section: Discussionmentioning

confidence: 73%

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

Self Cite

309

176

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“…Recently, Noiseux et al [19] showed a correlation between preoperative depression and moderate to severe pain with ROM after TKA at 6-month followup. Furthermore, patients with higher scores for catastrophic thinking, anxiety, posttraumatic stress disorder, and depression on several questionnaires are more likely to be taking opioid pain medications 1 to 2 months after musculoskeletal trauma than patients with lower scores [10]. Depression has also been associated with lower baseline and posttreatment MHQ scores in a general population of patients receiving treatment for atraumatic hand conditions [15].…”

Section: Discussionmentioning

confidence: 99%

What Is the Impact of Comorbidities on Self-rated Hand Function in Patients With Symptomatic Trapeziometacarpal Arthritis?

Calfee

Chu

Sorensen

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background The thumb trapeziometacarpal joint is one of the most common sites of arthritic degeneration prompting specialty care. Surgical treatment algorithms are based on radiographic arthritic progression. However, the pain and disability attributable to trapeziometacarpal arthritis do not correlate with arthritic stage, and depression has independently predicted poorer self-rated hand function both at baseline and after treatment in patients' atraumatic hand conditions. Questions/purposes (1) Does thumb trapeziometacarpal osteoarthritis impact both self-perceived general health and hand function? (2) Do depression and other comorbid conditions differentially impact patient-rated hand function based on the presence or absence of symptomatic trapeziometacarpal arthritis? (3) How do disease-specific, patient demographics and comorbid conditions impact selfreported hand function in patients with trapeziometacarpal osteoarthritis? Methods This cross-sectional study compared patients with symptomatic trapeziometacarpal osteoarthritis (n = 47) with matched control subjects without a symptomatic hand condition (n = 47). All participants self-reported medical (including depression) and musculoskeletal comorbidities and completed the SF-36 and the Michigan Hand Questionnaire (MHQ). Bivariate statistical analyses contrasted the patients with trapeziometacarpal osteoarthritis to control subjects. Linear regression modeling determined the impact of subject demographic data, comorbidity burden, and examination findings on total MHQ scores in patients with trapeziometacarpal arthritis. Results Patients with scored trapeziometacarpal osteoarthritis indicated poorer perceived general health on the SF-36 categories of limitations resulting from physical health (52 ± 29 versus 71 ± 31, mean difference 19 [95% confidence interval {CI}, 7-31], p = 0.003) and limitations resulting from emotional problems (50 ± 27 versus 67 ± 50, mean difference 17 [95% CI, 3-33], p = 0.022) compared with control subjects. Self-reported depression was associated with worse hand function (total MHQ score) in patients with trapeziometacarpal arthritis (69 ± 20 versus 49 ± 22: mean difference À20 [95% CI, À5 toÀ36], p = 0.012) but not in control patients (90 ± 13 versus 84 ± 20: mean difference À5 [95% CI, À8 to 19], p = 0.404). In multivariate modeling, depression (b À20, [95% CI, À5 to À34], p = 0.009) and upper extremity comorbidities (b À25, [95% CI, À10 to À40], p = 0.002) were both associated with reduced total MHQ scores in patients with trapeziometacarpal osteoarthritis, and those factors accounted for 34% of the variance in the MHQ score.

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“…The reason for a higher opioid consumption in men is unclear and might be related to a difference in effectiveness [22] but is also ascribed to sex differences in fear of addiction, previous pain experience, and tolerance to postoperative pain and opioid side effects [20]. A previous study found that the main factor associated with opioid use 1 to 2 months after musculoskeletal trauma was greater catastrophic thinking [7]. We did not find an effect of catastrophic thinking on second opioid prescriptions after distal radius fracture surgery, perhaps because the surgeons involved are quite strict with opioids and tend to identify and coach catastrophic thinking.…”

Section: Discussionmentioning

confidence: 99%

“…postoperative opioid use and psychological factors, catastrophic thinking, and health anxiety in particular [7,8].…”

Section: Introductionmentioning

confidence: 99%

What Factors are Associated with a Second Opioid Prescription after Treatment of Distal Radius Fractures with a Volar Locking Plate?

Teunis

Stoop

Park

et al. 2015

Hand (New York, N,Y.)

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Purpose Knowledge of factors associated with patient's requests for a second opioid prescription after volar plate fixation of a fracture of the distal radius might inform better pain management protocols and encourage decreased and safer use of opioids. This study tested the primary null hypothesis that there is no difference in demographics, prior opioid prescriptions, injury characteristics, and psychological factors between patients that do and do not receive a second opioid prescription following treatment volar locking plate after distal radius fracture. Patients and Methods We used data on 206 patients enrolled in one of two prospective studies. Their mean age was 53 years±SD 15, and 60 (30 %) were men. Forty-seven (23 %) patients received a second opioid prescription. We recorded additional demographics, AO fracture type, American Society for Anesthesiologists (ASA) classification, radiographic parameters at the time of injury prior to reduction and after surgery, and catastrophic thinking.Results Male sex (odds ratio [OR] 2.2, 95 % confidence interval [CI] 1.0-4.6, partial pseudo R 2 =0.018, P=0.044) and greater dorsal angulation of the articular surface on the lateral post injury radiograph (OR 0.98, 95 % CI 0.96 to 1.0, partial pseudo R 2 =0.033, P=0.040) were associated with a second opioid prescription after surgery (pseudo R 2 0.12, P=0.0071). Conclusions One measure of fracture severity (dorsal displacement) was independently associated with a second opioid prescription, but alone it accounted for 3.3 % of the variation. Other factors such as the patient's expectation prior to surgery, in particular the realization that injury and surgery hurt, might be addressed in future research. Level of Evidence Prognostic II

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Risk Factors for Continued Opioid Use One to Two Months After Surgery for Musculoskeletal Trauma

Cited by 233 publications

References 39 publications

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

What Is the Impact of Comorbidities on Self-rated Hand Function in Patients With Symptomatic Trapeziometacarpal Arthritis?

What Factors are Associated with a Second Opioid Prescription after Treatment of Distal Radius Fractures with a Volar Locking Plate?

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