Understanding the Opioid Epidemic: Factors Predictive of Inpatient and Postdischarge Prescription Opioid Use After Orthopaedic Trauma

Flanagan, Christopher D.; Wysong, Elena Fuell; Ramey, James S.; Vallier, Heather A.

doi:10.1097/bot.0000000000001256

Cited by 36 publications

(32 citation statements)

References 32 publications

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“…Among a population of patients who underwent shoulder arthroplasty, we found that preoperative opioid use increased the risk of postoperative opioid use and dependence. This is in concurrence with the hip and knee arthroplasty literature as well as those patients undergoing arthroscopic repairs 1 , 4 , 7 , 9 . It was also found that postoperative opioid use in these preoperative opioid-dependent patients continued even at 1-year follow-up (mean final follow-up of 47.1 months), indicating that patients who are opioid-dependent before shoulder arthroplasty remain chronically opioid-dependent even following surgery 4 .…”

Section: Discussionsupporting

confidence: 82%

“…Based on our results, patients undergoing RSA for RCA may be at the highest risk for postoperative opioid dependence. Perhaps we should limit postoperative prescriptions for these patients given recent studies among orthopedic trauma patients that found the opioid quantity dispensed at discharge after surgery is predictive of opioid use postoperatively 2 , 9 . The difference in opioid dependence rates is also important to note in that despite getting the same surgery, patients with preoperative OA require significantly less opioids than those with RCA.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis can predict opioid usage and dependence in reverse shoulder arthroplasty

et al. 2019

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Introduction: Reverse shoulder arthroplasty (RSA) has seen exponential growth over the past 2 decades. In addition, the recent focus on opioid usage and dependence has led to an increased understanding of the risk factors that lead to dependence. The purpose of this study was to examine associations between diagnosis and opioid consumption and dependence in RSA. Methods: A retrospective review was performed of 441 patients who had undergone a primary RSA from 2012 to 2016. Demographics were collected and patients were categorized based on top 4 diagnoses: glenohumeral osteoarthritis (n ¼ 129), irreparable rotator cuff tear (n ¼ 85), rotator cuff arthropathy (RCA) (n ¼ 184), and proximal humerus fracture (n ¼ 69). Opioid consumption within 90 days surrounding surgery was recorded from Prescription Drug Monitoring Programs. Logistic regression was performed. Results: Baseline characteristics for sex (P ¼ .0001), ethnicity (P ¼ .04), age (P ¼ .01), and preoperative opioid use (P ¼ .029) were significantly different. Patients with osteoarthritis had the lowest preoperative total morphine equivalents (TMEs) at 22.82 compared with fractures (53.36, P ¼ .02) and RCA (46.54, P ¼ .02). There was no significant difference in preoperative opioid dependence based on diagnosis (P ¼ .16); however, postoperatively, the RCA group had the highest dependence at 40.3% (P ¼ .03). In addition, there were no significant differences postoperatively in TMEs prescribed (P ¼ .197). The preoperatively dependent patients were 8 times more likely to remain dependent regardless of diagnosis. Conclusion: Patients with fractures consume the highest amounts of opioids surrounding surgery. Surgeons should tailor their preoperative education and pain management protocols accordingly based on diagnoses for RSA. In addition, increased awareness and protocols need to be implemented for preoperative opioid-dependent patients regardless of diagnosis.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Diagnosis can predict opioid usage and dependence in reverse shoulder arthroplasty

et al. 2019

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“…Chi-square, Fisher exact, and Student t -tests, with Welch corrections in the setting of unequal variance, were generated in the appropriate setting. Because previous research has described a negative correlation between age and opioid use, 5 , 13 , 14 age-matched cohorts were derived from the larger groups for more equitable comparison. To age-match the groups, each cohort was subdivided into 10-year age categories (<21, 21 to 30, …, 61 to 70, 71+), and the youngest and oldest age groups were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Multiple studies have demonstrated that reducing opioid prescriptions may diminish long-term opioid use. 5 , 6 This, in combination with interventions such as increasing regional anesthesia use and providing nonopioid medications for pain control, has been advocated to reduce opioid dependence while providing acceptable analgesia. 7 - 9 …”

mentioning

confidence: 99%

Five-year Trends in Opioid Prescribing Following Orthopaedic Trauma

et al. 2020

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Introduction: Legislatures across the country are passing new opioid prescribing laws. To understand the effects of this legislation, baseline autonomous shifts in physician opioid prescribing must be evaluated. Methods: The purpose of this retrospective dual cohort comparison study was to evaluate 5-year opioid prescribing trends in orthopaedic trauma patients. Demographic and injury information were collected on adult trauma patients with surgically managed orthopaedic fractures from 2012 (N = 190) and 2017 (N = 160). The amount of opioid medication prescribed from discharge to 1 year after the injury was collected. Opioid prescriptions were converted to morphine milligram equivalents (MMEs). The main outcome measure was opioid medication prescribed in 2017 versus 2012. Results: The cohorts were well-matched on sex, race, medical comorbidities, substance use, fracture location, Injury Severity Score, hospital length of stay, and intensive care unit admission metrics. However, the 2012 cohort was older than the 2017 cohort (51.9 versus 43.3 years, P < 0.001). When controlling for age, total opioid medication prescribed was greater in 2012 than in 2017 (1,680 versus 1,110 MME, P = 0.001). Patients in 2017 received both lower discharge prescriptions (523 versus 407 MME, P < 0.001) and lower total opioid prescription refill amounts (1,140 versus 766 MME, P = 0.037). The number of refills prescribed was equal, but patients received lower amounts of opioid medications per refill in 2017 (333 versus 243 MME, P < 0.001). Despite these differences, the percentage of patients ceasing prescription opioid use 1 year after injury was unchanged (90.6% versus 92.1%, P = 0.675). Discussion: Over 5 years, providers have successfully reduced the amount of opioid medication prescribed to surgically managed orthopaedic trauma patients through self-directed measures. The effects of opioid prescribing legislation should be viewed from this baseline.

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“…A total of three studies looked at age and opioid prescription practices. 13,16,18 Fandino et al 18 found that younger age was associated with increased opioid prescription upon discharge for patients who underwent hip fracture fixation (p < 0.0001). In addition, younger patients were found to have increased discharge MME (p = 0.004).…”

Section: Pico 3: Opioid Prescription Patterns Between Age Cohortsmentioning

confidence: 99%

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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Understanding the Opioid Epidemic: Factors Predictive of Inpatient and Postdischarge Prescription Opioid Use After Orthopaedic Trauma

Cited by 36 publications

References 32 publications

Diagnosis can predict opioid usage and dependence in reverse shoulder arthroplasty

Diagnosis can predict opioid usage and dependence in reverse shoulder arthroplasty

Five-year Trends in Opioid Prescribing Following Orthopaedic Trauma

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

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