Rate of Opioid Prescriptions for Patients With Acute Ankle Sprain

Finney, Fred T.; Gossett, Timothy D.; Hu, Hsou Mei; Waljee, Jennifer F.; Brummett, Chad M.; Walton, David M.; Talusan, Paul G.; Holmes, James R.

doi:10.7326/m19-0679

Cited by 11 publications

(13 citation statements)

References 4 publications

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“…Using methods previously published, patients who were diagnosed with an ankle sprain between January of 2008 and December of 2016 were identified by using International Statistical Classification of Diseases and Related Health Problems (ICD-9 and ICD-10) diagnosis codes (See Supplemental Digital Content 1, which lists ankle sprain diagnosis codes, http://links.lww.com/COP/A46). 15 The selected patients were a part of Clinformatics DataMart Database (OptumInsight, Eden Prairie, MN), a deidentified United States insurance claims database that captures person-specific clinical utilization and expenditures across inpatient, outpatient, and prescription drug services.…”

Section: Ethical Review and Study Designmentioning

confidence: 99%

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Factors associated with new persistent opioid use after ankle sprain: a cross-sectional analysis

Gossett

Finney

et al. 2021

Current Orthopaedic Practice

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Background:Chronic opioid use is a growing crisis in the United States. The authors examined the risk factors associated with new persistent opioid use in patients who had nonoperatively treated ankle sprains and offer evidence-based treatment recommendations for practitioners. Methods:A United States insurance claims database was used to select patients who underwent nonoperative treatment of an ankle sprain between January 2008 and December 2016. The authors examined opioid prescribing 1 yr before diagnosis and 6 mo after and defined new persistent opioid use as prescription fulfillment between 91 and 180 days after injury. We evaluated the effect of patient factors and amount prescribed on the likelihood of new persistent opioid use and the probability of refill within 30 days using logistical regression analysis. Results:A total opioid dose of 150 mg oral morphine equivalents (OMEs) prescribed within 7 days of diagnosis was the greatest modifiable risk factor for new persistent opioid use [adjusted odds ratio (aOR) 1.38, 95% confidence interval (CI), 1.28 to 1.49, P < 0.001] and for likelihood of refill within 30 days (aOR, 2.22, 95% CI, 2.10 to 2.35, P < 0.001). Additional factors included tobacco use, medical comorbidities, and certain pain and mental health disorders. Conclusions:New persistent opioid use is common in patients who had nonoperatively treated acute ankle sprains and is linked to identifiable patient and prescribing factors. Factors associated with new persistent opioid use include high initial prescribed dose, tobacco use, medical comorbidities, and certain pain and mental health disorders. These factors were also associated with a higher probability of refill. There is strong evidence-based support for the treatment of these injuries without opioids.

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Section: Ethical Review and Study Designmentioning

confidence: 99%

“…A previous study by Finney et al 15 demonstrated that 11.9% of patients with an acute ankle sprain received an opioid prescription, and 8.4% of these patients would go on to develop new persistent opioid use. Many of these opioid prescriptions were initiated in acute care settings, including emergency departments.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with new persistent opioid use after ankle sprain: a cross-sectional analysis

Gossett

Finney

et al. 2021

Current Orthopaedic Practice

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“…1,2 Recent publications clearly identify that opioid prescriptions from acute care visits contribute to chronic opioid use. 3,4 Specifically, prescribing opioids at hospital discharge to opioid-naive patients may increase the odds of chronic opioid use 1 yr after discharge fivefold. 5 This is of particular concern in the perioperative population, as several studies demonstrate that surgery is associated with an increased risk of persistent postoperative opioid utilization.…”

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confidence: 99%

Persistent Postoperative Opioid Prescription Fulfillment and Peripheral Nerve Blocks for Ambulatory Shoulder Surgery: A Retrospective Cohort Study

et al. 2021

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Background There is need to identify perioperative interventions that decrease chronic opioid use. The authors hypothesized that receipt of a peripheral nerve block would be associated with a lower incidence of persistent postoperative opioid prescription fulfillment. Methods This was a retrospective population-based cohort study examining ambulatory shoulder surgery patients in Ontario, Canada. The main outcome measure was persistent postoperative opioid prescription fulfillment. In opioid-naive patients (no opioid prescription fulfillment in 90 days preoperatively), this was present if an individual fulfilled an opioid prescription of at least a 60-day supply during postoperative days 90 to 365. In opioid-exposed (less than 60 mg oral morphine equivalent dose per day within 90 days preoperatively) or opioid-tolerant (60 mg oral morphine equivalent dose per day or above within 90 days preoperatively) patients, this was classified as present if an individual experienced any increase in opioid prescription fulfillment from postoperative day 90 to 365 relative to their baseline use before surgery. The authors’ exposure was the receipt of a peripheral nerve block. Results The authors identified 48,523 people who underwent elective shoulder surgery from July 1, 2012, to December 31, 2017, at one of 118 Ontario hospitals. There were 8,229 (17%) patients who had persistent postoperative opioid prescription fulfillment. Of those who received a peripheral nerve block, 5,008 (16%) went on to persistent postoperative opioid prescription fulfillment compared to 3,221 (18%) patients who did not (adjusted odds ratio, 0.90; 95% CI, 0.83 to 0.97; P = 0.007). This statistically significant observation was not reproduced in a coarsened exact matching sensitivity analysis (adjusted odds ratio, 0.85; 95% CI, 0.71 to 1.02; P = 0.087) or several other subgroup and sensitivity analyses. Conclusions This retrospective analysis found no association between receipt of a peripheral nerve block and a lower incidence of persistent postoperative opioid prescription fulfillment in ambulatory shoulder surgery patients. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

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“…Physicians now realize that nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen have similar pain relief profiles to opioids [3]. However, recent reports of a rate of opioid use of 12-25% for sprained ankles demonstrate how much more work needs to be done [4,5]. There is little evidence that surgeons have curtailed prescribing habits but, anecdotally, there is a movement in urology to stop unnecessary prescribing.…”

mentioning

confidence: 99%

The Shrinking Grey Zone of Postoperative Narcotics in the Midst of the Opioid Crisis: The No-opioid Urologist

Pekala

Jacobs

Davies

2020

European Urology Focus

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Rate of Opioid Prescriptions for Patients With Acute Ankle Sprain

Cited by 11 publications

References 4 publications

Factors associated with new persistent opioid use after ankle sprain: a cross-sectional analysis

Factors associated with new persistent opioid use after ankle sprain: a cross-sectional analysis

Persistent Postoperative Opioid Prescription Fulfillment and Peripheral Nerve Blocks for Ambulatory Shoulder Surgery: A Retrospective Cohort Study

The Shrinking Grey Zone of Postoperative Narcotics in the Midst of the Opioid Crisis: The No-opioid Urologist

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