Opioid Prescribing Patterns of Orthopedic Surgery Residents After Open Reduction Internal Fixation of Distal Radius Fractures

Bhashyam, Abhiram R.; Young, Jason D.; Qudsi, Rameez A.; Parisien, Robert L.; Dyer, George S.M.

doi:10.1016/j.jhsa.2018.11.003

Cited by 31 publications

(36 citation statements)

References 33 publications

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“…18 In a survey of orthopedic residents across 4 programs by Bhashyam et al, only 36.5% of residents reported receiving opioid prescribing training. 19 Implementation of a mandatory educational program has been shown to effectively reduce the amount of opioids and pills prescribed after lumbar spine surgery. 20 In summary, we found significant variability in opioid prescription following primary single-level lumbar microdiscectomy in both maximum daily MME and total number of pills prescribed.…”

Section: Discussionmentioning

confidence: 99%

Variability in Opioid Prescription Following Primary Single-Level Lumbar Microdiscectomy

Lê

Phan

Agatstein

et al. 2020

Global Spine Journal

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Study Design: Retrospective case series. Objectives: To evaluate the variability in opioid prescription following primary single-level lumbar microdiscectomy. Methods: We retrospectively reviewed consecutive patients who underwent primary single-level lumbar microdiscectomy. Only opioid-naïve patients ≥18 years old were included. Patients who had revision microdiscectomy, multilevel decompression, and/or any complication requiring prolonged hospital stay (>2 days) were excluded. The primary outcomes were the maximum daily dosage of opioids prescribed in morphine milligram equivalents (MME) and the number of pills prescribed (equivalent to 5 mg hydrocodone). Results: Between 2014 and 2019, 169 patients (90 men, 79 women) met inclusion criteria, with a mean age of 46.9 years. Surgery resulted in a statistically significant improvement in VAS (Visual Analogue Scale) score (6.4 to 2.5, P < .01). At discharge, 8 patients (4.7%) did not receive any opioid prescription. Of the remaining 161 patients, 1 patient (0.01%) received hydromorphone, 30 (18.6%) Percocet, 43 (26.7%) oxycodone, and 87 Norco (54.0%). The length of opioid prescription was 6.7 days. The maximum daily dosage of opioids prescribed was 70.4 MME (SD 32.1). The total number of pills prescribed was 89.4 (SD 54.7). Twenty-five patients (15.5%) received a refill prescription. Multivariate analysis demonstrated the operating service, prescriber, and hospital admission were statistically significant predictors of maximum daily MME. The prescriber and hospital admission were statistically significant predictors of total number of pills prescribed. Conclusions: We found significant variability in opioid prescription following primary single-level lumbar microdiscectomy. For standard spinal procedures like lumbar microdiscectomy, opioid-prescribing guidelines should be established to standardize postoperative pain management.

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Section: Discussionmentioning

confidence: 99%

Variability in Opioid Prescription Following Primary Single-Level Lumbar Microdiscectomy

Lê

Phan

Agatstein

et al. 2020

Global Spine Journal

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“…Previous work has demonstrated significant variation in opioid prescribing between countries, with US providers prescribing opioids more commonly and at higher doses. 10 , 11 To better contextualize US opioid prescribing, this study sought to examine how nonopioid prescribing varies between countries in total quantity, duration, and coprescription with opioid medications. Our study demonstrates clinically relevant differences in nonopioid and multimodal analgesic prescribing between the United States, Haiti, and the Netherlands.…”

Section: Discussionmentioning

confidence: 99%

“…This finding may at least partly explain the findings from our previous study which indicated higher opioid doses and prescription durations prescribed among the US residents for postoperative analgesia. 10 , 11 Prescribing opioid monotherapy is not without risks because previous work has noted an increased likelihood of adverse events associated with higher levels of opioid exposure. 36 In addition, recent work has indicated that opioids may also limit bone healing and callus formation and thus raise concern for opioid use at high doses or for prolonged durations.…”

Section: Discussionmentioning

confidence: 99%

“…For example, we recently demonstrated how opioid prescribing varies significantly between countries, with US providers prescribing opioids more frequently and at higher dosages than prescribers in the Netherlands and Haiti. 10 , 11 Yet, that work was limited to opioid prescriptions, and there are few quantitative comparative studies of international postoperative nonopioid prescribing patterns. 7 …”

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confidence: 99%

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Cross-Cultural Comparison of Nonopioid and Multimodal Analgesic Prescribing in Orthopaedic Trauma

Young¹,

Bhashyam

Parisien

et al. 2020

JAAOS Glob Res Rev

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Background: After musculoskeletal injury, US providers prescribe opioids more frequently and at higher dosages than prescribers in the Netherlands and Haiti; however, the extent of variation in nonopioid analgesic prescribing is unknown. The aim of our study was to evaluate how nonopioid prescribing by orthopaedic residents varies by geographic context. Methods: Orthopaedic residents in three countries in which residents are the primary prescribers of postoperative analgesia in academic medical centers (Haiti, the Netherlands, and the United States) responded to surveys using vignette-based musculoskeletal trauma case scenarios. The residents chose which medications they would prescribe for postdischarge analgesia. We quantified the likelihood and dose of acetaminophen or a nonsteroidal anti-inflammatory drug prescription. We constructed multivariable regressions with generalized estimating equations to describe differences in nonopiate prescription according to country, the resident's sex and training year, and the injury site and age in the test cases. Results: Compared with residents from the United States, residents from Haiti were more likely to prescribe nonopioids (odds ratio, 3.22 [confidence interval, 1.94 to 5.34], P < 0.0001) and residents from the Netherlands nearly always prescribed nonopioids. Of those cases where one or more opioid was prescribed, providers also prescribed a nonopioid (acetaminophen or nonsteroidal anti-inflammatory drug) in 345/603 (57.2%) of US, 152/152 (100%) of Dutch, and 69/97 (71.1%) of Haitian cases (Fisher exact test P value <0.0001). Finally, providers prescribed only nonopioids for pain control in 3/348 (0.86%) of US, 32/184 (17.4%) of Dutch, and 107/176 (60.8%) of Haitian cases (Fisher exact test P < 0.0001). Conclusions: When comparing multimodal analgesic patterns, US prescribers prescribed nonopioid analgesics less frequently than prescribers in two other countries, one low income and one high income, either in isolation or in conjunction with opioids.

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“…4 We used the regression coefficients for patient age, bony vs nonbony procedure, and anatomic location (forefoot/midfoot/hindfoot/ankle) from our consumption model as estimates of the difference in opioid requirement for different procedures in different age groups, because it is generally believed that some procedures in older vs younger patients may be more painful than others. 2,4,5 We compared all procedures against nonbony, forefoot procedures in patients <50 years old (our control group) as this was a common injury with the lowest opioid consumption (10 oxycodone 5-mg pills met the opioid requirement of 1 SD of patients). Because the regression coefficients reflect the additional pills needed over the 10 pills recommended for nonbony, forefoot procedures, the maximum initial opioid pills for other procedures was calculated as 10 pills plus the regression coefficient for that procedure (modulated by age).…”

Section: Discussionmentioning

confidence: 99%

Prospective Evaluation of Opioid Use After Adoption of a Prescribing Guideline for Outpatient Foot and Ankle Surgery

et al. 2019

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Background: In 2016, our provider group adopted an initial prescription opioid maximum guideline to reduce overprescription of opioids. The purpose of this study was to prospectively assess opioid consumption patterns following implementation of this guideline in patients undergoing outpatient foot and ankle surgery. Methods: Over a 1-year period, we prospectively analyzed opioid prescription and use patterns of 303 consecutive patients. Opioid consumption was verified by pill counts completed at the 2- and 6-week postoperative visits. The morphine equivalent dose was calculated for each prescription and converted to the equivalent 5-mg oxycodone “pill.” We used the regression coefficients from a regression model of opioid consumption to create a revised guideline for maximum initial opioid prescriptions based on patient age, bony vs nonbony procedure, and anatomic location (forefoot/midfoot/hindfoot/ankle). Results: On average, 37.4 pills were prescribed and 18.9 pills used (47.6% utilization). Only 17.2% of patients used their full prescription quantity. By 2 weeks, 88% of patients no longer used opioids. Only 1.3% of patients used prescription opioids beyond 6 weeks. Independent risk factors for increased opioid consumption were younger age ( P = .003), male sex ( P = .007), recent preoperative opioid use ( P = .019), bony procedures ( P < .001), and ankle/hindfoot procedures ( P = .016 and P < .001). Conclusion: This study showed the amount of opioid consumption for patients undergoing foot and ankle procedures. We present a modified guideline for the maximum initial prescription of opioids following outpatient foot and ankle procedures that can be used as a benchmark for further study in decreasing overprescribing. Level of Evidence: Level II, prospective observational cohort study.

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Opioid Prescribing Patterns of Orthopedic Surgery Residents After Open Reduction Internal Fixation of Distal Radius Fractures

Cited by 31 publications

References 33 publications

Variability in Opioid Prescription Following Primary Single-Level Lumbar Microdiscectomy

Variability in Opioid Prescription Following Primary Single-Level Lumbar Microdiscectomy

Cross-Cultural Comparison of Nonopioid and Multimodal Analgesic Prescribing in Orthopaedic Trauma

Prospective Evaluation of Opioid Use After Adoption of a Prescribing Guideline for Outpatient Foot and Ankle Surgery

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