Patient understanding regarding opioid use in an orthopaedic trauma surgery population: a survey study

Abstract Background Prior studies have assessed provider knowledge and factors associated with opioid misuse; similar studies evaluating patient knowledge are lacking. The purpose of this study was to assess the degree of understanding regarding opioid use in orthopaedic trauma patients. We also sought to determine the demographic factors and clinical and personal experiences associated with level of understanding. Methods One hundred and sixty-six adult orthopaedic trauma surgery patients across two clinical sites of an academic institution participated in an internet-based survey (2352 invited, 7.1% response rate). Demographic, clinical, and personal experience variables, as well as perceptions surrounding opioid use were collected. Relationships between patient characteristics and opioid perceptions were identified using univariate and multivariable logistic regressions. Alpha = 0.05. Results Excellent recognition (> 85% correct) of common opioids, side effects, withdrawal symptoms, and disposal methods was demonstrated by 29%, 10%, 30%, and 2.4% of patients; poor recognition (< 55%) by 11%, 56%, 33%, and 52% of patients, respectively. Compared with white patients, non-white patients had 7.8 times greater odds (95% confidence interval [CI] 1.9–31) of perceiving addiction discrepancy (p = 0.004). Employed patients with higher education levels were less likely to have excellent understanding of side effects (adjusted odds ratio [aOR] 0.06, 95% CI 0.006–0.56; p = 0.01) and to understand that dependence can occur within 2 weeks (aOR 0.28, 95% CI 0.09–0.86; p = 0.03) than unemployed patients. Patients in the second least disadvantaged ADI quartile were more knowledgeable about side effects (aOR 8.8, 95% CI 1.7–46) and withdrawal symptoms (aOR 2.7, 95% CI 1.0–7.2; p = 0.046) than those in the least disadvantaged quartile. Patients who knew someone who was dependent or overdosed on opioids were less likely to perceive addiction discrepancy (aOR 0.24, 95% CI 0.07–0.76; p = 0.02) as well as more likely to have excellent knowledge of withdrawal symptoms (aOR 2.6, 95% CI 1.1–6.5, p = 0.03) and to understand that dependence can develop within 2 weeks (aOR 3.8, 95% CI 1.5–9.8, p = 0.005). Conclusions Level of understanding regarding opioid use is low among orthopaedic trauma surgery patients. Clinical and personal experiences with opioids, in addition to demographics, should be emphasized in the clinical history.

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Which orthopaedic trauma patients need psychiatry consultation? A single institution pilot survey study

Current Orthopaedic Practice ◽

10.1097/bco.0000000000000619 ◽

2018 ◽

pp. 1

Author(s):

Sean T. Campbell ◽

Blake J. Schultz ◽

Amanda M. Franciscus ◽

Divy Ravindranath ◽

Julius A. Bishop

Keyword(s):

Survey Study ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Single Institution ◽

Pilot Survey

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Consenting Operative Orthopaedic Trauma Patients: Challenges and Solutions

ISRN Surgery ◽

10.1155/2014/354239 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Amin Kheiran ◽

Purnajyoti Banerjee ◽

Philip Stott

Keyword(s):

Phase 1 ◽

Operative Procedure ◽

Trauma Surgery ◽

National Standards ◽

Junior Doctors ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Phase 2 ◽

Consent Forms ◽

Surgical Trainees

Guidelines exist to obtain informed consent before any operative procedure. We completed an audit cycle starting with retrospective review of 50 orthopaedic trauma procedures (Phase 1 over three months to determine the quality of consenting documentation). The results were conveyed and adequate training of the staff was arranged according to guidelines from BOA, DoH, and GMC. Compliance in filling consent forms was then prospectively assessed on 50 consecutive trauma surgeries over further three months (Phase 2). Use of abbreviations was significantly reduced (P=0.03) in Phase 2 (none) compared to 10 (20%) in Phase 1 with odds ratio of 0.04. Initially, allocation of patient’s copy was dispensed in three (6% in Phase 1) cases compared to 100% in Phase 2, when appropriate. Senior doctors (registrars or consultant) filled most consent forms. However, 7 (14%) consent forms in Phase 1 and eleven (22%) in Phase 2 were signed by Core Surgical Trainees year 2, which reflects the difference in seniority amongst junior doctors. The requirement for blood transfusion was addressed in 40% of cases where relevant and 100% cases in Phase 2. Consenting patients for trauma surgery improved in Phase 2. Regular audit is essential to maintain expected national standards.

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Smoke-Free Recovery from Trauma Surgery: A Pilot Trial of an Online Smoking Cessation Program for Orthopaedic Trauma Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph14080847 ◽

2017 ◽

Vol 14 (8) ◽

pp. 847 ◽

Cited By ~ 2

Author(s):

Sam McCrabb ◽

Amanda Baker ◽

John Attia ◽

Zsolt Balogh ◽

Natalie Lott ◽

...

Keyword(s):

Smoking Cessation ◽

Pilot Trial ◽

Trauma Surgery ◽

Smoking Cessation Program ◽

Trauma Patients ◽

Orthopaedic Trauma

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690 Orthopaedic Trauma Surgery: Has the COVID Pandemic Affected Surgical Outcomes?

British Journal of Surgery ◽

10.1093/bjs/znab259.092 ◽

2021 ◽

Vol 108 (Supplement_6) ◽

Author(s):

T Edwards ◽

K Hristova ◽

S Shiels ◽

R Frostick ◽

E Lostis ◽

...

Keyword(s):

Postoperative Complications ◽

Upper Limb ◽

Lower Limb ◽

Surgical Outcomes ◽

Trauma Surgery ◽

Mortality Data ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Major Trauma Centre ◽

Age At Surgery

Abstract Aim To compare the surgical outcomes following orthopaedic trauma surgery before and during the COVID pandemic in an adult Major Trauma Centre. Method A retrospective chart review was conducted for all patients undergoing orthopaedic trauma surgery before (01/12/2019 to 29/02/2020) and during (01/03/2020 to 10/06/2020) the COVID pandemic. A Chi-square test was used to compare frequencies of type of anaesthetic used, postoperative ITU admission, any surgical complications and mortality. Data was collected 90 days after surgery. Results During the pre-COVID period, 501 patients (mean age at surgery 64y 4m; 222 male (44%)) underwent orthopaedic trauma surgery (395 lower limb (79%); 86 upper limb (17%); 28 pelvis (6%)) compared to 474 patients (mean age at surgery 61y 8m; 219 male (48%)) during the COVID period (388 lower limb (82%); 58 upper limb (12%); 23 pelvis (5%)). There was a significant increase in the use of a spinal as the main anaesthetic during the pandemic (9 (2%) vs 115 (24%), p < 0.001) and fewer trauma patients were admitted to ITU postoperatively (42 (8%) vs 16 (3%), p0.001). There was no difference in the rate of postoperative complications (103 (21%) vs 95 (20%), p0.841) or mortality at 90 days (42 (8%) vs 43 (9%), p0.703). Of the 244 COVID swabs done during the COVID period, 8 (3%) were positive. Conclusions Despite widespread operational disruption and a change in anaesthetic practice, there was no change in the rate of postoperative complications or mortality following orthopaedic trauma surgery.

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Accuracy of self-reported opioid use in orthopaedic trauma patients

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-03178-8 ◽

2022 ◽

Author(s):

Fady Y. Hijji ◽

Tyler Sanda ◽

Scott D. Huff ◽

Andrew W. Froehle ◽

Joseph D. Henningsen ◽

...

Keyword(s):

Trauma Patients ◽

Orthopaedic Trauma ◽

Opioid Use

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01 - A Pilot Study: Mental Health Support May Reduce Postinjury Opioid Use in Orthopaedic Trauma Patients Who Screen Positive for PTSD

10.26226/morressier.5cffabadf6074e97f94aad66 ◽

2019 ◽

Author(s):

Christopher Flanagan ◽

Heather A. Vallier

Keyword(s):

Mental Health ◽

Pilot Study ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Opioid Use ◽

Mental Health Support ◽

Health Support

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The Effect of a Life Care Specialist on Pain Management and Opioid-Related Outcomes Among Patients with Orthopaedic Trauma: Study Protocol for a Randomized Controlled Trial

10.21203/rs.3.rs-659890/v1 ◽

2021 ◽

Author(s):

Nicholas A. Giordano ◽

Jesse Seilern und Aspang ◽

J'Lynn Baker ◽

Cammie Wolf Rice ◽

Bailey Barrell ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Substance Use ◽

Pain Management ◽

Controlled Trial ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Life Care ◽

Opioid Use ◽

Randomized Controlled ◽

Care Specialist

Abstract Background:Orthopaedic trauma patients face complex pain management needs and are frequently prescribed opioids, leaving them at-risk for prolonged opioid use. To date, post-trauma pain management research has placed little emphasis on individualized risk assessments for misuse and systematically implementing non-pharmacologic pain management strategies. Therefore, a community-academic partnership was formed to design a novel position in the healthcare field (Life Care Specialist (LCS)), who will educate patients on the risks of opioids, tapering usage, safe disposal practices, and harm reduction strategies. In addition, the LCS teaches patients behavior-based strategies for pain management, utilizing well-described techniques for coping and resilience. This study aims to determine the effects of LCS intervention on opioid utilization, pain control, and patient satisfaction in the aftermath of orthopaedic trauma.Methods: In total, 200 orthopaedic trauma patients will be randomized to receive an intervention (LCS) or a standard-of-care control at an urban level 1 trauma center. All patients will be assessed with comprehensive social determinants of health and substance use surveys immediately after surgery (baseline). Follow-up assessments will be performed at 2-, 6-, and 12-weeks postoperatively, and will include pain medication utilization (morphine milligram equivalents), pain scores, and other substance use. In addition, overall patient wellness will be evaluated with objective actigraphy measures and patient-reported outcomes. Finally, a survey of patient understanding of risks of opioid use and misuse will be collected, to assess the influence of LCS opioid education.Discussion: There is limited data on the role of individualized, multimodal, non-pharmacologic, behavioral-based pain management intervention in opioid related risk-mitigation in high-risk populations, including the orthopaedic trauma patients. The findings from this randomized controlled trial will provide scientific and clinical evidence on the efficacy and feasibility of the LCS intervention. Moreover, the final aim will provide early evidence into which patients benefit most from LCS intervention. Trial registration: ClinicalTrials.gov NCT04154384. Registered on 11/6/2019 (last updated on 6/10/2021). https://clinicaltrials.gov/ct2/show/NCT04154384?term=life+care+specialist&draw=2&rank=1

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A National Survey of Ultra Clean Air Theatre Use in Orthopaedic Trauma

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363512x13311314195259 ◽

2012 ◽

Vol 94 (5) ◽

pp. 185-186

Author(s):

N Jarvis ◽

S Dheerendra ◽

D Chappell ◽

A Goel ◽

P Pidikiti

Keyword(s):

Total Joint Replacement ◽

Trauma Surgery ◽

Fragility Fractures ◽

Trauma Patients ◽

Orthopaedic Trauma ◽

Infection Rates ◽

Operating Theatres ◽

Deep Surgical Site Infection ◽

Clean Air ◽

The Cost

The consequences of deep surgical site infection (SSI) following orthopaedic operations can be devastating. Trauma patients, especially those suffering fragility fractures, tend to have less reserve and more co-morbidities than elective patients; infection in their case may be even more catastrophic. It is also expensive: Dreghorn et al calculated that revising infected arthroplasties was up to four times the cost of a primary total joint replacement. Maintaining low infection rates in trauma surgery depends on meticulous surgical technique, peri-operative antibiotics and scrupulous theatre standards, including the use of laminar or ultra clean air (UCA) operating theatres for sterile orthopaedic procedures.

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