Perioperative Opioid Use in Wrist Fusion
Neill Yun Li, MD1; Joseph A Gil, MD2; Alan H Daniels, MD1; Christopher J Got, MD2
1Brown University, Providence, RI, 2Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, RI
Wrist Fusion (WF) can be used to address painful end stage arthritis resulting from rheumatoid arthritis (RA), osteoarthritis (OA), or traumatic arthropathy (TA). Opioid use following surgical intervention in the United States and their associated complications has been a topic of concern. The purpose of this study was to examine the prevalence of preoperative and prolonged postoperative opioid use in patients undergoing WF as well as factors involved in prolonged postoperative opioid use.
Materials and Methods:
A private insurance database, PearlDiver, was reviewed for patients who underwent WF between 2007 and 2017 with a minimum of three months follow-up. Patients with preoperative narcotic use thirty days prior to index procedure, age, gender, race, history of OA, TA, or RA, and Charlson Comorbidity Index (CCI) were evaluated for risk of prolonged postoperative use. Regression analyses were used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) with p<0.05 considered significant.
A total of 1132 patients underwent WF with 19.5% (n=221) using narcotics preoperatively and 40.2% (n=455) using narcotics three months following TWA. The most significant predictors for prolonged postoperative use was preoperative use (OR 3.83, CI 2.64–5.16, p<0.001). When separating patients between RA, OA, and TA, those with history of OA were found to have the highest risk of prolonged use (OR 3.69, CI 2.56-5.38, p<0.001) followed by RA (OR 2.19, CI 1.42-3.36, p<0.001) and TA (OR 2.06, CI 1.56-2.91, p<0.001). Prolonged opioid use was associated with significant increase in complications involving cardiac, respiratory, and infection following WF (OR 2.74, CI 2.06-3.64, p<0.001).
Around 40% of patients continued to receive opioid analgesics three months following WF. Those with preoperative opioid use correlated most with opioid use three months after surgery. Specifically, patients with OA and preoperative narcotic use demonstrated the highest risk for prolonged opioid use. The use of opioids for patients that are to undergo WF can be a modifiable risk factor to diminish the risk of prolonged postoperative opioid use and postoperative complication.
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