What’s New in the Battle Against the Opioid Crisis in Hand Surgery: A Review

Seigerman, Daniel; Lutsky, Kevin; Kwok, Moody; Sodha, Samir; Fletcher, Daniel J.; Mazur, Donald; Beredjiklian, Pedro K.

doi:10.1016/j.jhsg.2018.10.003

Cited by 2 publications

(2 citation statements)

References 42 publications

(37 reference statements)

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“…Our findings are in keeping with the overall decline in the national opioid prescribing rate from 2012 to 2017 to the lowest rate in the past 10 years at 58.7 prescriptions per 100 persons. 24 Although our study cannot thoroughly assess the effects of specific legislation or policies, given the considerable heterogeneity in state-led interventions, previous literature has suggested that opioid-limiting regulations have been effective in changing prescribing patterns. For example, Reid et al 25 examined the impact of opioid-limiting laws on postoperative opioid prescribing and secondary outcomes after anterior cervical diskectomy and fusion by comparing a cohort of patients pre-law (December 1, 2015, to June 30, 2016) and post-law (June 1, 2017, to December 31, 2017).…”

Section: Discussionmentioning

confidence: 96%

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Opioid Prescription After Carpal Tunnel Release Is Declining Independent of State Laws

Cunningham

Saltzman

Lorenzana

et al. 2020

J Am Acad Orthop Surg

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Background: The opioid misuse crisis focused attention on opioid overprescribing prompting legislation, limiting prescribing. The purpose of this study was to evaluate of opioid filling surrounding carpal tunnel release (CTR) with the hypothesis that filling has decreased in response to state legislation. Methods: This is a retrospective, observational study of initial discharge, 30-day, 90-day, and 1-year cumulative opioid filling after CTR in a commercial insurance database between 2010 and 2018. All patients aged 18 and older undergoing CTR and with active insurance status for 6 months preoperative through 30 days, 90 days, and 1 year postoperative were considered for inclusion. Patients undergoing sameday distal radius fracture fixation were excluded. Initial and cumulative perioperative patient, state, and year-level opioid filling rates and volumes in oxycodone 5 mg equivalents (oxycodone 5-mg pills) were evaluated. Results: Patients filled mean volumes of 33, 72, and 144 oxycodone 5mg pills in the initial prescription, by 90 days post-op and by 1 year postop, respectively. First prescription opioid filling volume (35 oxycodone 5mg pills 2010 and 27 oxycodone 5-mg pills 2018, P , 0.001) and cumulative 90-day filling (96 oxycodone 5-mg pills 2010 and 56 oxycodone 5-mg pills 2018, P , 0.001) have decreased significantly from 2010 to 2018. Ten of 24 (41.7%) of states with opioid-limiting legislation had large (.5 oxycodone 5-mg pills), significant reductions in initial opioid filling volume after legislation. Five of 13 (38.5%) states without opioid-limiting legislation had similar reductions during the study period. Thirteen of 24 (54.2%) states with opioid-limiting legislation had large, notable reductions in 90-day opioid filling volume after legislation. Six of 13 (46.2%) states without opioid-limiting legislation had similar reductions during the study period. Conclusion: Initial and cumulative opioid filling surrounding CTR has decreased significantly since 2010. However, opioid legislation did not result in substantial changes in rates of large, significant reductions in statespecific opioid prescribing.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Opioid Prescription After Carpal Tunnel Release Is Declining Independent of State Laws

Cunningham

Saltzman

Lorenzana

et al. 2020

J Am Acad Orthop Surg

View full text Add to dashboard Cite

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Risk Factors and Reasons for Emergency Department Visits Within 30 Days of Elective Hand Surgery: An Analysis of 3,261 Patients

Benage

Core

Bass

et al. 2022

J Hand Surg Asian-Pac Vol

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Background: The frequency of hand and elbow surgeries occurring in outpatient and elective settings is on the rise. Emergency department (ED) visits in the postoperative period are increasingly used as quality measures for surgical care. The aim of this study is to determine the number of postoperative ED visits, the primary reason for these visits, and to identify risk factors associated with these visits. Methods: We examined all elective hand and elbow procedures performed at two hospitals within a single healthcare network between 2008 and 2017. A total of 3,261 patients met the study criteria. Descriptive statistics were calculated for our population, followed by univariate and multivariate analyses, to identify risk and protective factors associated with ED visits in the first 30 days after surgery. Results: Eighty-seven of 3,261 patients presented to the ED within 30 days of their operation (2.7%). The most common reasons for ED visits were related to pain (28.7%), swelling (26.4%), and concerns for infection (20.7%). Univariate analysis indicated history of drug use, number of procedures, smoking history, and serum albumin <3.5 mg/dL as risk factors for returns to the ED. Multivariate analysis identified history of drug use, number of procedures, and serum albumin <3.5 mg/dL as independent risk factors. Smoking history failed to achieve statistical significance as an independent risk factor. Both univariate and multivariate analyses identified age >60 years as protective for postoperative ED visits. Conclusions: ED visits within the first 30 days after elective hand surgery are relatively common, despite remarkably low complication rates among these procedures. This information may help to improve risk stratification in these patients, and to aid in the development of enhanced postoperative follow-up strategies to reduce unnecessary utilization of emergency medical services. Level of Evidence: Level III (Therapeutic)

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What’s New in the Battle Against the Opioid Crisis in Hand Surgery: A Review

Cited by 2 publications

References 42 publications

Opioid Prescription After Carpal Tunnel Release Is Declining Independent of State Laws

Opioid Prescription After Carpal Tunnel Release Is Declining Independent of State Laws

Risk Factors and Reasons for Emergency Department Visits Within 30 Days of Elective Hand Surgery: An Analysis of 3,261 Patients

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