Misuse of Opioids in Orthopaedic Postoperative Patients

Gangavalli, Anup K.; Malige, Ajith; Terres, George; Rehman, Saqib; Nwachuku, Chinenye

doi:10.1097/bot.0000000000000741

Cited by 39 publications

(37 citation statements)

References 31 publications

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“…Half of their patients required opioid medication for only 2 days after the surgical procedure. Investigations in the orthopaedic trauma literature have highlighted the importance of socioeconomic status in predicting postoperative opioid consumption, with unemployed, lowerincome, and less-educated patients more likely to believe that they were underprescribed pain medication and seek additional opioid medication beyond that prescribed by their surgeon 18,19 .…”

Section: Discussionmentioning

confidence: 99%

“…The selection bias involving patients who agreed to study participation may have influenced our results if these patients differed systematically from those who declined enrollment. Additionally, our suburban study location resulted in few underinsured or low-socioeconomic-status patients being enrolled, which is a group known to require higher levels of opioids after orthopaedic procedures 18,19 . Some surgical variability may have occurred within our procedure groupings for which we were unable to account.…”

Section: Discussionmentioning

confidence: 99%

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Opioid Consumption After Knee Arthroscopy

Wojahn

Bogunovic

Brophy

et al. 2018

The Journal of Bone and Joint Surgery

103

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Background: The opioid epidemic in the United States has placed increased pressure on physicians to engage in responsible opioid prescribing practices. However, surgeons currently have little information to guide their postoperative prescription decision-making. The purpose of this study was to assess opioid consumption after knee arthroscopy and identify preoperative factors that may predict higher opioid usage.Methods: A prospective observational study of 221 patients was conducted in patients undergoing outpatient knee arthroscopy for meniscal repair, partial meniscectomy, debridement, chondroplasty, or loose body removal. Participants recorded their daily opioid consumption in a postoperative pain diary. Total opioid consumption was calculated from counts of remaining pills at the 2-week and 6-week postoperative office visits. Variables, including age, sex, body mass index, smoking status, alcohol consumption, preoperative pain severity and duration, preoperative opioid usage, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and the Connor-Davidson Resilience Scale, were evaluated for an association with opioid consumption.Results: Total opioid consumption ranged from 0 to 188 pills, with a median of 7 pills (hydrocodone 5-mg equivalents).Forty-six percent of patients took £5 pills, 59% took £10 pills, and 81% took £20 pills. Fifty-six percent of patients had discontinued opioid usage by the third postoperative day. Eighty-eight percent of patients had surplus opioid medication at the time of the final follow-up. Patients undergoing meniscal repair, smokers, and those taking preoperative opioids were significantly more likely to take ‡20 pills (p < 0.05). Conclusions:The median number of pills taken after knee arthroscopy is 7, with the majority of patients consuming £20 pills. Meniscal repair, smoking, and preoperative opioid usage were associated with higher postoperative opioid consumption.Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Opioid Consumption After Knee Arthroscopy

Wojahn

Bogunovic

Brophy

et al. 2018

The Journal of Bone and Joint Surgery

103

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“…Prior opioid use has been shown to be associated with adverse clinical outcomes in surgical and trauma patients including higher pain, greater rates of postoperative morbidity, and lower levels of satisfaction. [1][2][3] Opioid exposure in the context of a traumatic injury may also increase the potential for dependence, misuse, and abuse. [1][2][3] A history of prescription opioid abuse is a significant risk factor for conversion to heroin use.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3] Opioid exposure in the context of a traumatic injury may also increase the potential for dependence, misuse, and abuse. [1][2][3] A history of prescription opioid abuse is a significant risk factor for conversion to heroin use. 4 The potential for these adverse events may be even higher among patients who sustain trauma to the musculoskeletal system, a group previously found to have elevated rates of chemical dependence, risk-taking behavior, concomitant behavioral health disorders, and other sociodemographic characteristics associated with opioid abuse such as underemployment and lower socioeconomic status.…”

Section: Introductionmentioning

confidence: 99%

Prior Prescription Opioid Use and Its Influence on Opioid Requirements After Orthopedic Trauma

Chaudhary

Keudell

Bhulani

et al. 2019

Journal of Surgical Research

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Background: Prior opioid use has been shown to be associated with adverse outcomes in surgical and trauma patients. We sought to evaluate the influence of prior opioid use on prescription opioid requirements after orthopedic trauma. Materials and methods: This was a retrospective review of TRICARE claims (2006-2014). We evaluated the records of 11,752 patients treated for orthopedic injuries. Surveillance for prior opioid exposure extended to 6 mo before the traumatic event, with similar postinjury surveillance. Preinjury opioid use was categorized as unexposed, exposed without sustained use (nonsustained users), and sustained use (6 mo or longer of continuous opioid prescriptions without interruption). Multivariable Cox proportional hazard models were used to adjust for confounding and determine factors independently associated with the discontinuation of prescription opioid use after traumatic injury. Results: Prior opioid exposure among nonsustained users (hazard ratio 0.78; 95% CI 0.74, 0.83) and sustained use at the time of injury (hazard ratio 0.40; 95% CI: 0.35, 0.47) were associated with lower likelihoods of opioid discontinuation. Additional factors associated with lower likelihoods of opioid discontinuation included our proxy for lower socioeconomic status, history of depression or anxiety, injury severity, and intensive care unit admission. Conclusions: Prior opioid use is one of the strongest predictors of continued use following treatment, along with socioeconomic status, behavioral health disorders, and severity of injury. Appropriate discharge planning and early engagement of ancillary services in

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“…Given the recent trend in the abuse of prescription of opioids, a study examined identifying patterns of postoperative opioid misuse among patients with orthopaedic trauma 24 . The results of the survey completed by 182 patients revealed that 19.2% of patients felt undermedicated, 12.6% admitted to using pain medications at a higher dose than prescribed, and 9.3% admitted to using external opioids.…”

Section: Opioid Usementioning

confidence: 99%