scholarly journals Conventional Ankle Sprain Treatment is Associated with Alarmingly High Rates of Persistent Opioid Use

2019 ◽  
Vol 4 (2) ◽  
pp. 2473011419S0000
Author(s):  
Fred T. Finney ◽  
Timothy D. Gossett ◽  
Hsou Mei Hu ◽  
Jennifer Waljee ◽  
Chad Brummett ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Household Income ◽  
Nonoperative Treatment ◽  
Patient Specific ◽  
Ankle Sprains ◽  
Median Household Income ◽  
Opioid Use ◽  
Patient Factors ◽  
Opioid Prescription ◽  
Factors Associated

Category: Ankle Introduction/Purpose: The opioid epidemic has been defined by over-prescribing by practitioners and increasing misuse, abuse, and diversion of opioids by patients. Orthopedic surgeons are the fourth largest prescriber of opioid medications and have a unique opportunity to play a prominent role in the solution. Many perceived barriers to such a solution have now been eliminated. For example, it has been demonstrated that neither the amount nor duration of opioid prescription correlates with patient satisfaction. To address this epidemic, it is important to first understand rates of new persistent opioid use following specific injuries and to identify patient-specific risk factors. In this study, we evaluated new persistent opioid use following nonoperatively treated ankle sprains, one of the most common orthopaedic injuries seen in any healthcare system. Methods: A widely accepted insurance claims database was used to identify patients who underwent nonoperative treatment of an ankle sprain between January 2008 and December 2016. None had an opioid prescription filled in the period of 12 months to 7 days prior to treatment (defined as “opioid naïve”). We evaluated peri-treatment and post-treatment opioid prescription fulfillment to analyze prescribing patterns and continuation of opioid use. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after treatment. Logistic regression analysis was used to evaluate the effect of patient factors, including age, gender, median household income, tobacco use, mental health and pain disorders, and medical comorbidities on the likelihood of new persistent use. Results: 42,445 patients were identified who underwent nonoperative treatment of an ankle sprain and received an opioid prescription. The overall rate of new persistent opioid used following nonoperative treatment of ankle sprains was 9.3%. Rates of continued opioid use were significantly increased among patients who received an opioid dose prescribed in the peri-treatment period that was in the top 25th percentile of total oral morphine equivalents. In addition, patient-specific factors which were associated with new persistent opioid use included female gender, tobacco use, certain mental health disorders, comorbid conditions, and pre-existing arthritis. Patient factors associated with lower rates of new persistent opioid use included higher level education and median household income of $100,000 or more. Conclusion: Chronic opioid use is a major problem, even in the setting of relatively minor musculoskeletal injuries. Defining the problem and understanding contributing factors to this epidemic are paramount to developing a solution. Ankle sprains represent an orthopaedic injury which does not warrant opioid use for pain control. In this series, an alarming number of patients who sustained an ankle sprain were treated with an opioid medication, and 9.3% of these patients continued opioid use after three months. Understanding the risk factors associated with this problem provides a foundation upon which to address this sometimes lethal, public health problem.

scholarly journals New Persistent Opioid Use Following Operative Treatment of Ankle Fractures Compared to Nonoperatively Treated Fractures

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005 ◽  
Author(s):  
Timothy Gossett ◽  
Fred Finney ◽  
Paul Talusan ◽  
James Holmes
Keyword(s):  
Public Health ◽  
Household Income ◽  
Ankle Fractures ◽  
Patient Specific ◽  
Opioid Use ◽  
Distal Fibula ◽  
Opioid Prescription ◽  
Fibula Fracture ◽  
Closed Treatment ◽  
Chronic Opioid Use

Category: Trauma Introduction/Purpose: Chronic opioid use is a major public health concern in the United States. Orthopaedic surgeons prescribe 8% of narcotics in the U.S. while only comprising 2.5% of U.S. physicians. Understanding that neither the amount nor duration of opioid prescription correlates with patient satisfaction, orthopaedic surgeons have a unique opportunity to play a prominent role in the solution. In order to address and mitigate this epidemic, it is important to first understand rates of new persistent opioid use following specific orthopaedic procedures and to identify patient-specific risk factors. Methods: Using a widely accepted insurance claims database, we identified patients who underwent surgical treatment of common ankle fractures patterns (bimalleolar, trimalleolar, and isolated distal fibula) between January 2008 and December 2016. None had an opioid prescription filled in the period of 12 months to 15 days prior to treatment (defined as “opioid naïve”). Opioid naïve patients who underwent closed treatment of a distal fibula fracture served as a comparative group. We evaluated peri-treatment and post-treatment opioid prescription fulfillment. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after the procedure. Logistic regression was used to evaluate the effect of patient factors, including surgery type, age, gender, median household income, mental health and pain disorders on the likelihood of new persistent use. Results: There was no significant difference in new persistent opioid use rates overall following surgical treatment of ankle fractures (8.4%) compared to closed fibula fracture treatment (7.4%), and all treatment groups demonstrated high rates of new persistent use. Two surgically treated fracture subtypes, treatment of bimalleolar ankle fractures and treatment of trimalleolar ankle fractures with fixation of posterior lip, demonstrated significantly higher new persistent opioid use rates (Figure). Rates were significantly increased among patients who received an opioid dose prescribed in the peri-treatment period that was in the top 25th percentile of total oral morphine equivalents. Patient-specific factors which were associated with new persistent opioid use included certain mental health disorders, comorbid conditions, arthritis, tobacco use, female gender, and household income greater than $100,000. Conclusion: Chronic opioid use, even in opioid naïve patients, is a major problem following orthopaedic procedures. To decrease the rate of chronic opioid use, it is important to first understand and define the rate of persistent use following these procedures. The overall new persistent opioid use following surgical fixation of ankle fractures was similar to the rate of persistent use in patients who underwent closed treatment of a fibula fracture. Understanding these high persistent use rates and the risk factors that may play a role in this problem provides a foundation upon which to address this sometimes lethal public health problem.

scholarly journals New Persistent Opioid Use Following Common Forefoot Procedures for Treatment of Hallux Valgus

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0005 ◽  
Author(s):  
Fred Finney ◽  
Timothy Gossett ◽  
David Walton ◽  
Paul Talusan ◽  
James Holmes
Keyword(s):  
Public Health ◽  
Surgical Treatment ◽  
Hallux Valgus ◽  
Metatarsal Osteotomy ◽  
Foot And Ankle ◽  
Opioid Use ◽  
Patient Factors ◽  
Opioid Prescription ◽  
Factors Associated ◽  
First Metatarsal

Category: Bunion Introduction/Purpose: Chronic opioid use and abuse is one of the greatest public health challenges in the United States and continues to worsen. Orthopaedic surgeons stand at #4 on the list of top prescribers of opioid analgesics by specialty and are squarely positioned to have an impact on the problem. A recent study revealed an 8% prevalence of new persistent opioid usage following abdominal surgery. At present, the incidence of persistent opioid use after foot and ankle surgery is largely unknown. Operative bunion correction is one of the most commonly performed elective foot and ankle surgeries in this country. We sought to determine the incidence of new persistent opioid use following surgical treatment of hallux valgus and to identify patient factors associated with persistent opioid use. Methods: A nationwide insurance claims data set from January 2010 to June 2015 was used to identify opioid naive patients (defined as patients with no prior opioid use 12 months prior to injury) who underwent surgical treatment of hallux valgus with either a proximal or distal first metatarsal osteotomy. The incidence of new persistent opioid use, defined by opioid prescription fulfillment between 90 and 180 days after surgery was then calculated. Data were assessed for patient factors which may be predictors of new persistent opioid use including surgery type, health insurance type, age, gender, household income, and comorbidities. Results: A total of 38,312 patients underwent surgical treatment of hallux valgus with either a distal or proximal first metatarsal osteotomy and filled a perioperative opioid prescription. The rate of new persistent opioid use among all patients was 5.6%. The majority of patients (90%) underwent treatment with a distal metatarsal osteotomy. Patients who underwent treatment with a proximal metatarsal osteotomy were more likely to have new persistent opioid use (aOR: 1.16; p=0.04). Logistic regression analysis demonstrated that patient factors independently associated with new persistent opioid use included depression, anxiety, alcohol and substance abuse disorders, and certain preoperative pain disorders. Age, gender, and income were not associated with new persistent opioid use. Conclusion: Despite rising national attention, opioid abuse continues to be a growing epidemic. In order for foot and ankle surgeons to help solve this problem, it must first be better defined. New persistent opioid use following surgical treatment of hallux valgus affects a substantial, growing number of patients. Fifty percent of patients using opioids for 3 months will be using them at 5 years. Understanding patient factors associated with persistent opioid use can help clinicians identify and counsel at-risk patients and ultimately focus strategies and interventions aimed at mitigating and eliminating this massive public health problem.

New Persistent Opioid Use and Associated Risk Factors Following Treatment of Ankle Fractures

2019 ◽  
Vol 40 (9) ◽  
pp. 1043-1051 ◽  
Author(s):  
Timothy D. Gossett ◽  
Fred T. Finney ◽  
Hsou Mei Hu ◽  
Jennifer F. Waljee ◽  
Chad M. Brummett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Ankle Fracture ◽  
Opioid Use ◽  
Patient Factors ◽  
Distal Fibula ◽  
Opioid Prescription ◽  
Opioid Dose ◽  
Closed Treatment ◽  
Open Treatment

Background:The aim of this study was to define the rate of new persistent opioid use and risk factors for persistent opioid use after operative and nonoperative treatment of ankle fractures.Methods:Using a nationwide insurance claims database, Clinformatics DataMart Database, we identified opioid-naïve patients who underwent surgical treatment of unstable ankle fracture patterns between January 2009 and June 2016. Patients who underwent closed treatment of a distal fibula fracture served as a comparative group. We evaluated peritreatment and posttreatment opioid prescription fills. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after the procedure. Logistic regression was used to evaluate the effect of patient factors, and the differences of the effect were tested using Wald statistics. The adjusted persistent use rates were calculated. A total of 13 088 patients underwent treatment of an ankle fracture and filled a peritreatment opioid prescription.Results:When compared with closed treatment of a distal fibula fracture, only 2 surgical treatment subtypes demonstrated significantly increased rates of persistent use compared with the closed treatment group: open treatment of bimalleolar ankle fracture (adjusted odds ratio [aOR], 1.32; 95% CI, 1.10-1.58; P = .002) and open treatment of trimalleolar ankle fracture with fixation of posterior lip (aOR, 1.47; 95% CI, 1.04-2.07; P = .027). Rates were significantly increased (aOR, 1.56; 95% CI, 1.34-1.82; P < .001) among patients who received a total peritreatment opioid dose that was in the top 25th percentile of total oral morphine equivalents. Factors independently associated with new persistent opioid use included mental health disorders, comorbid conditions, tobacco use, and female sex.Conclusion:All ankle fracture treatment groups demonstrated high rates of new persistent opioid use, and persistent use was not directly linked to injury severity. Instead, we identified patient factors that demonstrated increased risk of persistent opioid use. Limiting the peritreatment opioid dose was the largest modifiable risk factor related to new persistent opioid use in this privately insured cohort.Level of Evidence:Level III, retrospective cohort study.

Patient Factors Associated With Prolonged Postoperative Opioid Use After Total Knee Arthroplasty

2018 ◽  
Vol 33 (8) ◽  
pp. 2449-2454 ◽  
Author(s):  
Robert S. Namba ◽  
Anshuman Singh ◽  
Elizabeth W. Paxton ◽  
Maria C.S. Inacio
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Opioid Use ◽  
Patient Factors ◽  
Factors Associated ◽  
Total Knee

scholarly journals Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery

2021 ◽  
pp. 219256822110357
Author(s):  
Eric Y. Montgomery ◽  
Mark N. Pernik ◽  
Zachary D. Johnson ◽  
Luke J. Dosselman ◽  
Zachary K. Christian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Medical Center ◽  
Lumbar Fusion ◽  
Academic Medical Center ◽  
Opioid Use ◽  
Retrospective Case ◽  
Opioid Prescription ◽  
Factors Associated ◽  
Chronic Opioid Use

Study Design: Retrospective case control. Objectives: The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery. Methods: In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-mo postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses. Results: Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race ( P = 0.001), preoperative narcotic ( P < 0.001) or anxiety/depression medication use ( P = 0.002), and intraoperative long lumbar ( P < 0.001) or thoracic spine surgery ( P < 0.001). Lower patient income was also a risk factor for script renewal ( P = 0.01). Script renewal at 12 months was associated with younger age ( P = 0.006), preoperative narcotics use ( P = 0.001), and ≥4 levels of lumbar fusion ( P < 0.001). Renewals at 3-mo and 12-mo had no association with MME given during the hospital stay or with the usage of PCA ( P > 0.05). Conclusion: The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.

Patient factors associated with prolonged opioid use after rotator cuff repair

2017 ◽  
Vol 26 (5) ◽  
pp. e151
Author(s):  
Robert W. Westermann ◽  
Christopher Anthony ◽  
Nicholas Bedard ◽  
Natalie A. Glass ◽  
Matthew J. Bollier ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Opioid Use ◽  
Patient Factors ◽  
Factors Associated ◽  
Cuff Repair

Variation in Delivery of Palliative Radiotherapy to Persons Dying of Cancer in Nova Scotia, 1994 to 1998

2001 ◽  
Vol 19 (14) ◽  
pp. 3323-3332 ◽  
Author(s):  
Grace M. Johnston ◽  
Christopher J. Boyd ◽  
Paul Joseph ◽  
Maureen MacIntyre
Keyword(s):  
Nova Scotia ◽  
Household Income ◽  
Palliative Radiotherapy ◽  
Cancer Center ◽  
Median Household Income ◽  
Sequential Decisions ◽  
Canadian Province ◽  
Factors Associated ◽  
Lower Likelihood ◽  
Equity Of Access

PURPOSE: To examine sociodemographic and clinical variables associated with provision of palliative radiotherapy (RT) to persons dying of cancer. METHODS: The Nova Scotia Cancer Registry was used to identify 9,978 adults who were dying of cancer between 1994 and 1998 in the Canadian province of Nova Scotia. RT records from between April 1992 and December 1998 were obtained from the provincial treatment database. Multivariate analysis identified factors associated with two sequential decisions determining provision of palliative RT in the last 9 months of life: likelihood of receiving an RT consultation with a radiation oncologist and, given a consultation, likelihood of being treated with palliative RT. RESULTS: The likelihood of having a consultation decreased with age (20 to 59 years v 80+ years: odds ratio [OR], 4.43 [95% confidence interval, 3.80 to 5.15]), increased with community median household income (> $50,000 v < $20,000: OR, 1.31 [1.02 to 1.70]), was higher for residents closer to the cancer center (< 25 km v 200+ km: OR, 2.47 [2.16 to 2.83]), increased between 1994 and 1998 (OR, 1.34 [1.16 to 1.56]), varied by cause of death (relative to thoracic cancers, head and neck: OR, 1.75 [1.31 to 2.33]; gynecologic: OR, 0.35 [0.27 to 0.44]), and was greater for those who had prior RT (OR, 2.20 [1.89 to 2.56]). Similar associations were observed when outcome was the provision of palliative RT given a consult, with one notable exception: prior RT was associated with a lower likelihood of receiving palliative RT (OR, 0.48 [0.40 to 0.58]). CONCLUSION: Variations observed in delivery of palliative RT should prompt further investigation into equity of access to clinically appropriate, palliative radiation consultation and treatment.

scholarly journals Opioid Prescription Patterns and Risk Factors Associated With Opioid Use in the Netherlands

2019 ◽  
Vol 2 (8) ◽  
pp. e1910223 ◽  
Author(s):  
Ajda Bedene ◽  
Willem M. Lijfering ◽  
Marieke Niesters ◽  
Monique van Velzen ◽  
Frits R. Rosendaal ◽  
...  
Keyword(s):  
Risk Factors ◽  
The Netherlands ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Prescription Patterns ◽  
Factors Associated

Risk Factors for Prolonged Opioid Use After Open Treatment of Distal Radius Fractures

Hand ◽  
2021 ◽  
pp. 155894472098810
Author(s):  
Mia M. Qin ◽  
Charles D. Qin ◽  
Chirag M. Shah
Keyword(s):  
Risk Factors ◽  
Distal Radius ◽  
Significant Risk ◽  
Distal Radius Fractures ◽  
Opioid Use ◽  
Radius Fractures ◽  
Opioid Prescription ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Open Treatment

Background The objective of this study was to evaluate factors associated with postoperative opioid use after open treatment of distal radius fractures. Methods The Humana insurance claims database was queried for open treatment of distal radius fractures by Current Procedural Terminology codes. The search was further refined to identify patients who filled an opioid prescription within 6 weeks after their surgery. The study’s outcomes were: (1) limited postoperative opioid use, defined as filling a prescription once in the 6-week to 6-month period after surgery; and (2) persistent postoperative opioid use, defined as filling a prescription more than once in the 6-week to 6-month period after surgery. Logistic regression models were performed to identify factors associated with limited and persistent postoperative opioid use. Subgroup analyses were performed among opioid-naïve patients and those with open fractures. Results This study identified 9141 of 19 220 total patients with limited and persistent opioid use. Significant risk factors included nonhome discharge, inpatient surgical setting, long-term pain, tobacco abuse, and age less than 65 years. Of note, both preoperative opioid use within 1 month before surgery (odds ratio [OR], 2.6; 95% confidence interval [CI], 2.2-2.9) and preoperative opioid use between 1 and 6 months before surgery (OR, 4.0; 95% CI, 3.7-4.4) were significantly associated with persistent postoperative opioid use. Conclusions This study has identified numerous risk factors associated with postoperative opioid use after open treatment of distal radius fractures. Understanding these risk factors is the first step toward reducing postoperative opioid use.

Factors associated with new persistent opioid use after ankle sprain

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Timothy D. Gossett ◽  
Fred T. Finney ◽  
Hsou Mei Hu ◽  
Jennifer F. Waljee ◽  
Chad M. Brummett ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Opioid Use ◽  
Factors Associated
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