Background The misuse of opioid analgesics is a major public health concern, and guidelines regarding postoperative opioid use are sparse. We examined the use of opioids following outpatient upper extremity procedures. We hypothesized that opioid use varies widely by procedure and patient factors. Methods We studied opioid prescriptions among 296,452 adults ages ≥ 18 years who underwent carpal tunnel release, trigger finger release, cubital tunnel release, and thumb carpometacarpal (CMC) arthroplasty from 2009 to 2013. We analyzed insurance claims drawn using Truven Health MarketScan Commercial Claims and Encounters, which encompasses over 100 health plans in the United States. Using multivariable regression, we compared the receipt of opioids, number of days supplied, indicators of inappropriate prescriptions, and number of refills by patient factors. Results In this cohort, 59% filled a postoperative prescription for opioid medication, and 8.8% patients had an indicator of inappropriate prescribing. The probability of filling an opioid prescription declined linearly with advancing age. In multivariate analysis, patients who had previously received opioids were more likely to fill a postoperative opioid prescription (66% vs. 59%), receive longer prescriptions (24 vs. 5 days), receive refills following surgery (24% vs. 5%), and have at least one indicator of potentially inappropriate prescribing (19% vs 6%). Conclusions Current opioid users are more likely to require postoperative opioid analgesics for routine procedures, and more likely to receive inappropriate prescriptions. More evidence is needed to identify patients who derive the greatest benefit from opioids in order to curb opioids prescriptions when alternative analgesics may be equally effective and available.

Hedgehog particles (HPs) replicating the spiky geometry of pollen grains revealed surprisingly high dispersion stability regardless of whether their hydrophobicity/hydrophilicity matches that of the media or not. This property designated as omnidispersibility is attributed to the drastic reduction of van der Waals interactions between particles coated with stiff nanoscale spikes as compared to particles of the same dimensions with smooth surfaces. One may hypothesize but it remains unknown, however, whether HPs modified with polymers or nanoparticles (NPs) would retain this property. Surface modifications of the spikes will expand the functionalities of HPs, making possible their utilization as omnidispersible carriers. Here, we show that HPs carrying dense conformal coatings made by layer-by-layer (LBL/LbL) assembly maintain dispersion stability in environments of extreme polarity and ionic strength. HPs, surface-modified by multilayers of polymers and gold NPs, are capable of surface-enhanced Raman scattering (SERS) and overcome the limited colloidal stability of other SERS probes. The agglomeration resilience of HPs leads to a greater than one order of magnitude increase of SERS intensity as compared to colloids with smooth surfaces and enables simultaneous detection of several targets in complex media with high ionic strength. Omnidispersible optically active colloids open the door for rapid multiplexed SERS analysis in biological fluids and other applications.