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Notable Variability in Opioid-prescribing Practices After Common Orthopaedic Procedures
Sophia A Traven1, Daniel L Brinton, Shane K Woolf
1From the Department of Orthopaedics and Physical Medicine, the Medical University of South Carolina, Charleston, SC (Dr. Traven, Dr. Brinton, Dr. Woolf, Dr. Leddy, Dr. Slone), and the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA (Dr. Gottschalk).
Summary
Opioid prescribing patterns after orthopedic surgery show significant regional differences. Prescriptions were lowest in the region hardest hit by the opioid epidemic, suggesting opportunities for improved guidelines.
Area of Science:
- Orthopaedic Surgery
- Pain Management
- Public Health
Background:
- Opioid prescriptions following surgery are a significant concern.
- Understanding regional variations in prescribing is crucial for addressing the opioid crisis.
Purpose of the Study:
- To evaluate nationwide trends and regional variability in opioid prescriptions after common orthopaedic procedures.
- To identify patterns that can inform guidelines for reducing excess postoperative opioid use.
Main Methods:
- Retrospective analysis of 73,921 opioid-naive patients from the MarketScan database (2015-2016).
- Analysis of median oral morphine equivalents and interquartile ranges by region for initial and 90-day post-op prescriptions.
- Included procedures: carpal tunnel release, ACL reconstruction, meniscectomy, ankle/radius fracture fixation, rotator cuff repair, ACDF, and total joint arthroplasties.
Main Results:
- Significant regional variability in opioid prescriptions was observed for most procedures, excluding total joint arthroplasty.
- Soft-tissue procedures required the fewest prescription refills, while total joint arthroplasties required the most.
- Opioid prescriptions were notably lower in the region most affected by the opioid epidemic.
Conclusions:
- Regional variability in opioid prescribing is evident for many orthopaedic procedures.
- Prescribing patterns may be influenced by regional factors, including the opioid epidemic's impact.
- Findings can guide the re-evaluation of recommendations and development of quality improvement guidelines to curb excessive opioid prescribing.
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