Implementing Prescribing Guidelines for Upper Extremity Orthopedic Procedures: A Prospective Analysis of Postoperative Opioid Consumption and Satisfaction

Abstract

Background: A lack of established opioid-prescribing guidelines has prompted recent studies to propose preliminary guidelines to mitigate inadvertent overprescribing, diversion, and abuse. The purpose of our study was to assess the efficacy of a specific set of opioid-prescribing guidelines by prospective evaluation of patient consumption and satisfaction. Methods: During a consecutive period, all patients undergoing outpatient upper extremity surgical procedures were postoperatively prescribed opioids based on published guidelines that were specific to the anatomical location and procedure being performed. At the first postoperative visit, surgical details, opioid consumption patterns, and prescription efficacy and satisfaction were recorded. Results: A total of 201 patients reported any amount of prescription use, resulting in a mean consumption of 5.5 pills. Patients who underwent soft tissue procedures reported the lowest requirement (4.2 pills) compared with those who underwent fracture repairs (6.7 pills) or arthroscopy and arthroplasty/fusion procedures (8.7 pills). Patients undergoing hand procedures consumed fewer opioids (3.9 pills) compared with those undergoing wrist (6.3 pills) or elbow (8.1 pills) procedures. Of the patients requiring opioids, 82% reported being satisfied or at least neutral to the prescribed quantity ( P < .001), and 92% reported being satisfied or at least neutral to the prescribed opioid analgesic efficacy ( P < .001). Overall, the study refill request rate was 13%. Conclusions: Although the proposed guidelines tended to exceed patient need, the study confirmed strong patient satisfaction and an overall refill request rate of only 13%. We conclude that following anatomical and procedure-specific opioid-prescribing guidelines is an effective method of prescribing opioids postoperatively after upper extremity.

Prospective Randomized Study Examining Preoperative Opioid Counseling on Postoperative Opioid Consumption after Upper Extremity Surgery

“…Based on our study findings and other studies, we would recommend prescribing 10 to 20 opioid pills after shoulder and elbow surgeries. 3,20…”

“…Based on our study findings and other studies, we would recommend prescribing 10 to 20 opioid pills after shoulder and elbow surgeries. 3,20 In terms of implementation of preoperative opioid counseling, we recommend surgeons create a prerecorded educational video that can be played on smart device, tablet, or viewed online. We have generally found that patients are more receptive to watching a video then reading educational material.…”

Preoperative Opioid Use Results in Greater Postoperative Opioid Consumption After Thumb Basal Joint Arthroplasty

“…The observed trend toward statistical significance suggests that lower initial opioid prescriptions are reasonable. Similarly, Adalbert and Ilyas 36 found high patient satisfaction and low refill rates with low numbers of procedure- and anatomy-based postoperative opioid prescriptions.…”

The “Top 10” Psychosocial Factors Affecting Orthopaedic Outcomes

“…Kim et al demonstrated that opiates are prescribed up to 3 times more than necessary after upper extremity surgery 47 , and Saini et al found that double the necessary number of opiates was prescribed after foot and ankle surgery 48 . Multiple strategies to optimize outcomes for these patients have been suggested, including algorithms to predict prolonged opioid use [49][50][51] , adjusted prescribing protocols 47,52 , and multi-modal pain medication regimens [53][54][55] . Providers should be aware of these potential complications and should limit the number of opioids prescribed preoperatively and postoperatively.…”