Opioid Consumption Patterns and Prolonged Opioid Use Among Opioid-Naïve Ankle Fracture Patients

2021 ◽  
pp. 193864002199292
Author(s):  
Hope Skibicki ◽  
Sundeep Saini ◽  
Ryan Rogero ◽  
Kristen Nicholson ◽  
Rachel J. Shakked ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
Monitoring Program ◽  
Opioid Consumption ◽  
Consumption Patterns ◽  
Utilization Rate ◽  
Opioid Use ◽  
Index Procedure ◽  
Postoperative Visit ◽  
Fracture Surgery

Introduction Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate postoperative opioid consumption patterns as well as the incidence of prolonged opioid use among opioid-naïve patients following ankle fracture surgery. Methods Included patients underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture over a 1-year period. At patients’ first postoperative visit, opioid pills were counted and standardized to the equivalent number of 5-mg oxycodone pills. Prolonged use was defined as filling a prescription for a controlled substance more than 90 days after the index procedure, tracked by the New Jersey Prescription Drug Monitoring Program up to 1 year postoperatively. Results At the first postoperative visit, 173 patients consumed a median of 24 out of 40 pills prescribed. The initial utilization rate was 60%, and 2736 pills were left unused. In all, 32 (18.7%) patients required a narcotic prescription 90 days after the index procedure. Patients with a self-reported history of depression (P = .11) or diabetes (P = .07) demonstrated marginal correlation with prolonged narcotic use. Conclusion Our study demonstrated that, on average, patients utilize significantly fewer opioid pills than prescribed and that many patient demographics are not significant predictors of continued long-term use following outpatient ankle fracture surgery. Large variations in consumption rates make it difficult for physicians to accurately prescribe and predict prolonged narcotic use. Level of Evidence: Level III

scholarly journals Opioid Consumption Patterns and the Risk of Prolonged Opioid Use Among Opioid-Naïve Patients Following Ankle Fracture Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0006
Author(s):  
Hope Skibicki ◽  
Sundeep Saini ◽  
Ryan Rogero ◽  
Kristen Nicholson ◽  
Rachel J. Shakked ◽  
...  
Keyword(s):  
Ankle Fracture ◽  
The United States ◽  
Opioid Consumption ◽  
Consumption Patterns ◽  
Opioid Use ◽  
Index Procedure ◽  
Factors Associated ◽  
Tibial Plafond ◽  
Significant Difference ◽  
Fracture Surgery

Category: Ankle Introduction/Purpose: Over the past two decades, the number of opioids dispensed in the United States has nearly tripled. Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Statewide Prescription Drug Monitoring Programs (PDMPs) have been implemented to deter overprescribing and help monitor information pertaining to suspected abuse. The purpose of this study was to assess the immediate postoperative opioid consumption patterns as well as the incidence of new prolonged opioid use among opioid naïve patients following ankle fracture surgery. Methods: This was a retrospective review of prospectively collected data. Patients were included if they underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture between October 2016 and September 2017. Patients were excluded if they received any narcotic prescriptions prior to the date of the initial injury. Patient demographics, medical history, fracture pattern, and opioid prescription and consumption details were collected. The morphine equivalent dose was calculated for each prescription and then converted to the equivalent of a 5-mg oxycodone “pill”. The New Jersey PDMP was used to determine all prescriptions of controlled substances filled up to 1 year postoperatively. Prolonged use was defined as filling a postoperative prescription for a controlled substance 90 days after the index procedure. Linear regression analysis was performed to identify independent factors associated with immediate postoperative opioid consumption and repeated to identify factors associated with prolonged use. Results: One-hundred seventy-one patients were included in this study. At the first postoperative visit, patients consumed a median of 24 pills, whereas the median number prescribed was 40. This resulted in an initial utilization rate of 60% and 2,736 pills left unused. Additionally, we found that 18.7% (n=32) of patients required a narcotic prescription after 90 days from the index procedure. There was no statistically significant difference found between specific fracture type (isolated distal fibula, bimalleolar, trimalleolar) and prolonged opioid consumption, however tibial plafond fractures could not be included due to insufficient sample size (n=5). Patients with a self-reported history of depression (p=.094) or diabetes (p=.097) demonstrated marginal correlation with prolonged narcotic use. Conclusion: Our study demonstrated that patients who underwent outpatient surgical fixation of an ankle or tibial plafond fracture were initially overprescribed narcotics by nearly 67%, leaving a significant quantity of pills unused for potential abuse or diversion. 18.7% of originally opioid naïve patients required continued analgesia 90 days after the index procedure, however large variations in consumption rates make it difficult for physicians to predict prolonged narcotic use.

scholarly journals The association between initial opioid type and long-term opioid use after hip fracture surgery in elderly opioid-naïve patients

2020 ◽  
Vol 20 (4) ◽  
pp. 755-764
Author(s):  
Amalie H. Simoni ◽  
Lone Nikolajsen ◽  
Anne E. Olesen ◽  
Christian F. Christiansen ◽  
Søren P. Johnsen ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Pain Treatment ◽  
Population Based ◽  
Opioid Use ◽  
Calendar Time ◽  
Opioid Prescription ◽  
Hip Fracture Surgery ◽  
Opioid Users ◽  
Fracture Surgery

AbstractObjectivesLong-term opioid use after hip fracture surgery has been demonstrated in previously opioid-naïve elderly patients. It is unknown if the opioid type redeemed after hip surgery is associated with long-term opioid use. The aim of this study was to examine the association between the opioid type redeemed within the first three months after hip fracture surgery and opioid use 3–12 months after the surgery.MethodsA nationwide population-based cohort study was conducted using data from Danish health registries (2005–2015). Previously opioid-naïve patients registered in the Danish Multidisciplinary Hip Fracture Registry, aged ≥65 years, who redeemed ≥1 opioid prescription within three months after the surgery, were included. Long-term opioid use was defined as ≥1 redeemed prescription within each of three three-month periods within the year after hip fracture surgery. The proportion with long-term opioid use after surgery, conditioned on nine-month survival, was calculated according to opioid types within three months after surgery. Adjusted odds ratios (aOR) for different opioid types were computed by logistic regression analyses with 95% confidence intervals (CI) using morphine as reference. Subgroup analyses were performed according to age, comorbidity and calendar time before and after 2010.ResultsThe study included 26,790 elderly, opioid-naïve patients with opioid use within three months after hip fracture surgery. Of these patients, 21% died within nine months after the surgery. Among the 21,255 patients alive nine months after surgery, 15% became long-term opioid users. Certain opioid types used within the first three months after surgery were associated with long-term opioid use compared to morphine (9%), including oxycodone (14%, aOR; 1.76, 95% CI 1.52–2.03), fentanyl (29%, aOR; 4.37, 95% CI 3.12–6.12), codeine (13%, aOR; 1.55, 95% CI 1.14–2.09), tramadol (13%, aOR; 1.56, 95% CI 1.35–1.80), buprenorphine (33%, aOR; 5.37, 95% CI 4.14–6.94), and >1 opioid type (27%, aOR; 3.83, 95% CI 3.31–4.44). The proportion of long-term opioid users decreased from 18% before 2010 to 13% after 2010.ConclusionsThe findings suggest that use of certain opioid types after hip fracture surgery is more associated with long-term opioid use than morphine and the proportion initiating long-term opioid use decreased after 2010. The findings suggest that some elderly, opioid-naïve patients appear to be presented with untreated pain conditions when seen in the hospital for a hip fracture surgery. Decisions regarding the opioid type prescribed after hospitalization for hip fracture surgery may be linked to different indication for pain treatment, emphasizing the likelihood of careful and conscientious opioid prescribing behavior.

The Effects of Anesthetic Technique on Postoperative Opioid Consumption in Ankle Fracture Surgery

2016 ◽  
Vol 32 (10) ◽  
pp. 870-874 ◽  
Author(s):  
Kristian P. Christensen ◽  
Ann M. Møller ◽  
Jesper K. Nielsen ◽  
Tobias W. Klausen ◽  
Rune Sort
Keyword(s):  
Ankle Fracture ◽  
Opioid Consumption ◽  
Anesthetic Technique ◽  
Fracture Surgery

Risk Factors for Prolonged Opioid Use After Ankle Fracture Surgery

2021 ◽  
pp. 193864002110291
Author(s):  
Matthew S. Broggi ◽  
Philip O. Oladeji ◽  
Corey Spenser ◽  
Rishin J. Kadakia ◽  
Jason T. Bariteau
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Odds Ratio ◽  
Ankle Fracture ◽  
Significant Risk ◽  
Patient Characteristics ◽  
Low Back ◽  
Opioid Use ◽  
Increased Risk ◽  
Fracture Surgery

Background The incidence of ankle fractures is increasing, and risk factors for prolonged opioid use after ankle fracture fixation are unknown. Accordingly, the purpose of this study was to investigate risk factors that lead to prolonged opioid use after surgery. Methods The Truven MarketScan database was used to identify patients who underwent ankle fracture surgery from January 2009 to December 2018 based on CPT codes. Patient characteristics were collected, and patients separated into 3 cohorts based on postoperative opioid use (no refills, refills within 6 months postoperative, and refills within 1 year postoperatively). The χ2 test and multivariate analysis were performed to assess the association between risk factors and prolonged use. Results In total, 34 691 patients were analyzed. Comorbidities most highly associated with prolonged opioid use include 2+ preoperative opioid prescriptions (odds ratio [OR] = 11.92; P < .001), tobacco use (OR = 2.03; P < .001), low back pain (OR = 1.81; P < .001), depression (OR = 1.48; P < .001), diabetes (OR = 1.34; P < .001), and alcohol abuse (OR = 1.32; P < .001). Conclusion Opioid use after ankle fracture surgery is common and may be necessary; however, prolonged opioid use and development of dependence carries significant risk. Identifying those patients at an increased risk for prolonged opioid use can aid providers in tailoring their postoperative pain regimen. Levels of Evidence Prognostic, Level III

The Impact of Preoperative opioid use on complications, readmission, and cost following Ankle Fracture Surgery

Injury ◽  
2021 ◽  
Author(s):  
Philip O. Oladeji ◽  
Matthew S. Broggi ◽  
Corey Spencer ◽  
John Hurt ◽  
Roberto Hernandez-Irizarry
Keyword(s):  
Ankle Fracture ◽  
Opioid Use ◽  
The Impact ◽  
Fracture Surgery

scholarly journals How Does Perioperative Ketorolac Affect Opioid Consumption and Pain Management After Ankle Fracture Surgery?

2020 ◽  
Vol 478 (1) ◽  
pp. 144-151 ◽  
Author(s):  
Elizabeth L. McDonald ◽  
Joseph N. Daniel ◽  
Ryan G. Rogero ◽  
Rachel J. Shakked ◽  
Kristen Nicholson ◽  
...  
Keyword(s):  
Pain Management ◽  
Ankle Fracture ◽  
Opioid Consumption ◽  
Fracture Surgery

scholarly journals The Preemptive Effect of Pregabalin Single Dose on Opioid Consumption after surgery of Mandible Fracture: The Double-Blinded Clinical Trial

2019 ◽  
Author(s):  
Dawood Aghamohammadi ◽  
Haleh Farzin ◽  
Solmaz Fakhari ◽  
Mehdi Khanbabyi
Keyword(s):  
Clinical Trial ◽  
Single Dose ◽  
Intervention Group ◽  
Opioid Consumption ◽  
Preemptive Therapy ◽  
Mandibular Fractures ◽  
Opioid Use ◽  
Control Groups ◽  
And Control ◽  
Fracture Surgery

Background: Currently, the administration of non-opioid analgesics as a preemptive treatment has been approved by the surgeons of jaw due to lack of side effects of opioids in jaw surgery. However, which medicine as a pre-medication has a good result, is a controversy. Therefore, the aim of this study was to investigate the effect of preemptive therapy by pre-gabalin single dose on opioid consumption rate after surgery on mandibular fractures. Methods: This double-blind clinical trial was conducted in Tabriz Imam Hospital in 2012 on 60 patients who were undergoing mandibular fracture surgery. Patients were classified as intervention and control groups and the intervention group consumed one pregabalin capsule 300 milligrams with 50 ml of water half an hour before surgery. The amount of opioid use in the first eight hours after surgery was measured and recorded in both groups. Results: Opioid use in both groups was decreased with time- spending. There was also a significant relationship between opioid use in both intervention and control groups (P <0.001). Conclusion: Pregabalin premedication could have analgesic effects in lower jaw fracture surgery and decrease opioid use after surgery.

scholarly journals A Prospective Evaluation of Opioid Consumption Following Orthopaedic Foot and Ankle Surgery

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0010
Author(s):  
Sundeep Saini ◽  
Elizabeth McDonald ◽  
Kristen Nicholson ◽  
Ryan Rogero ◽  
Megan Chapter ◽  
...  
Keyword(s):  
Drug Prescription ◽  
Median Number ◽  
Opioid Consumption ◽  
Consumption Patterns ◽  
Utilization Rate ◽  
Foot And Ankle ◽  
Narcotic Drug ◽  
Opioid Prescription ◽  
Forefoot Surgery ◽  
Ankle Surgery

Category: Other Introduction/Purpose: The purpose of our study was to assess opioid consumption patterns following outpatient orthopaedic foot and ankle procedures in order to develop a pragmatic approach to narcotic drug prescription. Methods: Patients undergoing outpatient orthopaedic foot and ankle procedures who met inclusion criteria had the following prospective information collected: patient demographics, preoperative health history and Visual Analog Scale (VAS), anesthesia type, procedural details, and opioid prescription and consumption details. Utilization rates were compared using the Man-Whitney Test or the Kruskall-Wallis analysis of variance test with post-hoc Dunn’s multiple comparison test. Results: A total of 1,009 of 1,027 patients were included in this study (mean age: 49 years). Overall, patients consumed a median of 20 pills whereas the median number of pills prescribed was 40. This resulted in a utilization rate of 51% and nearly 21,196 pills left unused. Patients who received forefoot surgery used 6 pills less than those receiving hindfoot/ankle surgery (p=0.002). Patients between the ages of 60-79 consumed significantly less than those between 18-59 years old (p<0.012). Patients with preoperative VAS score =77 (p=0.002) or self-reported anxiety (p=0.070) a had an increase in opioid consumption compared to those who did not. Conclusion: Our study demonstrates that patients who undergo orthopaedic foot and ankle procedures are overprescribed narcotic medication by nearly twice the amount that is actually consumed. This leads to a significant surplus of narcotics available for potential diversion. We recommend that surgeons judiciously administer opioid prescriptions based on their patients’ consumption patterns and anatomic location of surgery.

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