Study Design: Retrospective cohort study Objective: On January 1, 2018, the Strengthen Opioid Misuse Prevention (STOP) Act was implemented to increase oversight over opioid prescriptions in North Carolina. The aim of this study is to evaluate the legislation’s efficacy in reducing opioid prescriptions following facial fracture repair. Methods: A retrospective chart review of patients who sustained maxillofacial fractures and underwent repair from January 1, 2015 through December 31, 2019 at a level 1 trauma center was performed. The North Carolina Controlled Substance Database was used to quantify perioperative opioid prescriptions in morphine milligram equivalents (MME). Average MME per patient was compared between 2 groups, patients who underwent surgery before the NC STOP Act came into effect and patients who underwent treatment after. This comparison was also performed on case type subgroups including surgically treated fractures of the orbit, mandible, midface, and multiple regions. A student’s t-test was used to compare before and after groups in all analyses. Results: Of the 253 patients who met inclusion criteria, 146 were in the before group, and 107 were in the after group. There was a statistically significant, 30.9% decrease in overall average MME prescribed after the NC STOP Act was enacted. A statistically significant decrease was noted in patients who had facial fractures of multiple regions. Conclusion: Since the implementation of the NC STOP Act in 2018, there have been statistically and clinically significant decreases in the amount of opioids prescribed following surgical management of facial fractures.
controlled for demographics, comorbidities, and hospital characteristics.RESULTS: From 49 institutions, of 4,958 patients with strip craniectomy, 1,493 (30%) did not receive LA, 107 (2%) received epinephrine-free LA, and 3,358 (68%) received epinephrine-containing LA. Of 6,364 patients with cranial vault construction, 2,313 (36%) had no LA, 301 (5%) had epinephrine-free LA, and 3,750 (59%) had epinephrine-containing LA. In strip craniectomy: operative complication and prolonged length of stawere independent of LA status (p > 0.1). Patients with no LA experienced increased cost compared with those having epinephrine-containing LA (adjusted odds rato [AOR] 1.41; 95% CI, 1.16 to 1.72; p < 0.001). No significant difference in cost was detected between LA without and with epinephrine (AOR 1.42; 95% CI, 0.70 to 2.65; p ¼ 0.299). In cranial vault reconstruction: epinephrinefree LA was associated with lower complication rate (AOR 0.56; 95% CI, 0.32 to 0.91; p ¼ 0.028), but higher odds of increased cost (AOR 2.12; 95% CI, 1.58 to 2.82; p < 0.001) compared with epinephrine-containing LA. Epinephrine-containing LA was not significantly different from epinephrine-free LA in terms of length of stay (p ¼ 0.058), and from no LA with respect to complication and likelihood of high cost (p > 0.2).CONCLUSIONS: Epinephrine-containing LA can protect against increased cost compared with no LA in strip craniectomy. In vault reconstruction, epinephrine-free LA might be associated with lower complication rate but higher cost compared with epinephrine-containing LA.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.