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

Abstract

Purpose: Thumb basal joint arthroplasty surgery is a common hand surgery after which patients often require opioids. To better understand safe opioid consumption patterns, this study sought to identify risk factors for filling a second prescription and/or prolonged opioid use (prescription over 6 months after the surgery). Preoperative opioid use was hypothesized to show an association with greater postoperative opioid use. Methods: A retrospective review of consecutive patients who underwent primary thumb basal joint arthroplasty was conducted, yielding 110 patients for analysis. Demographic and clinical data were collected. Opioid prescription data were extracted from 6 months before the surgery to 9 months after the surgery using a state prescription drug monitoring program. Bivariate and multivariate analyses were performed for filling a second opioid prescription or filling an opioid prescription over 6 months after the surgery. Results: All the patients filled their initial postoperative prescription. Of the 110 patients, 26.4% filled an opioid prescription before the surgery, 42% filled a second postoperative prescription, and 14.5% were still consuming opioids over 6 months after the surgery. Patients using preoperative opioids had 7-fold higher odds of filling a second opioid prescription and 37-fold higher odds of prolonged use. No other demographic or clinical factors, including the type of procedure or number of initial opioids prescribed, were associated with increased use of postoperative opioids. Of all the opioid prescriptions filled after the initial postoperative prescription, only 9.3% were prescribed by a surgeon's office. Conclusions: Patients who undergo thumb basal joint arthroplasty with preoperative opioid use have much greater odds of filling a second opioid prescription and prolonged use after the surgery. Low initial surgeon-provided opioid dosages did not correlate to filling a second prescription, indicating that lower initial doses are feasible. Finally, nearly all opioid-naïve patients who filled a second opioid prescription received them from providers other than a surgeon, indicating the need for greater communication with nonsurgical providers simultaneously caring for patients in the perioperative period. Type of study/level of evidence: Therapeutic III.

Evidenced-Based Opioid Prescribing Recommendations Following Hand and Upper-Extremity Surgery

“…After common hand and upper-extremity surgeries, inadvertent postoperative opioid prescribing can lead to dependency, abuse, diversion, death, and poor surgical and nonsurgical treatment outcomes; however, guidelines for appropriate opioid dosing and analgesic strategies are lacking. 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 …”

“…5 , 7 Greater initial prescriptions are associated with higher postoperative opioid usage in hand surgery. 23 , 24 , 25 Opioid use after most soft tissue hand surgeries is <5 opioid tablets, and even 0 when nonopioid analgesics are recommended. 5 , 7 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 Opioid use after bony surgeries is higher than that for soft tissue surgeries.…”

“…5 , 7 Greater initial prescriptions are associated with higher postoperative opioid usage in hand surgery. 23 , 24 , 25 …”

“…Several studies have shown that larger initial prescriptions were associated with a higher postoperative opioid usage in common procedures, including cubital tunnel release, trigger finger release, thumb CMC arthroplasty, and carpal tunnel release. 23 , 24 , 25 Yeung et al 26 showed that hand surgery patients retained unused postoperative opioids in 78% of cases, which may lead to diversion and abuse. Fortunately, there has been a trend toward reducing opioid overprescription by upper-extremity surgeons.…”