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Critical Risk Factors for Opioid Demand after Pelvic and Acetabular Fracture Surgery.

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Area of Science:

  • Orthopaedic Surgery
  • Pain Management
  • Health Services Research

Background:

  • Opioid demand following pelvic and acetabular fracture surgery is not fully understood.
  • Identifying predictors of opioid use is crucial for effective pain management and resource allocation.

Purpose of the Study:

  • To investigate factors associated with perioperative opioid demand in patients undergoing operative fixation of pelvic and acetabular injuries.
  • To identify specific fracture patterns and patient characteristics linked to increased opioid consumption.

Main Methods:

  • Retrospective analysis of 743 patients undergoing operative fixation for pelvic and acetabular injuries.
  • Multivariable linear and logistic regression models were employed to assess associations between baseline factors and opioid prescription filling.
  • Opioid prescription data was collected for three distinct timeframes: 1-month pre-op to 90-days post-op, 3-months post-op to 1-year post-op, and 1-month pre-op to 1-year post-op.

Main Results:

  • Patients filled prescriptions averaging 111.2 (1-month pre-op to 90-days post-op) and 200.3 (1-month pre-op to 1-year post-op) 5-mg oxycodone pills.
  • Operatively treated acetabular fractures, specifically wall, transverse, and two-column patterns, were associated with the highest opioid demand.
  • Pre-injury opioid use and a history of drug abuse were identified as primary non-surgical drivers of opioid demand.

Conclusions:

  • Acetabular fracture characteristics, pre-injury opioid use, and drug abuse are significant risk factors for increased perioperative opioid prescription filling.
  • Understanding these predictors can inform targeted pain management strategies and opioid stewardship in orthopaedic trauma surgery.
  • Further research into non-opioid pain management modalities for these complex fractures is warranted.