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American Association for Hand Surgery

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Overall opioid consumption is not associated with the amount of opioids administered and prescribed on the day of upper extremity surgery
Bryan Hozack, MD, Rothman Institute, Philadelphia, PA

Introduction:

Orthopaedic surgeons need to better understand the effect their opioid prescribing habits may have on their patients. Prescription Drug Monitoring Programs (PDMPs) accurately record the amount of controlled substance prescriptions filled. The purpose of our study was to evaluate whether the type of procedure or initial amount of opioids prescribed postoperatively would lead to increased opioids consumed.



Materials & Methods:

Consecutive patients undergoing upper extremity surgery at one surgical center were enrolled. The medical record and Pennsylvania PDMP website were used to record all prescriptions of controlled substances consumed intraoperatively, consumed in the recovery room, and prescriptions filled for six months following the procedure. Morphine equivalent units (MEUs) were used to quantify the amount of opioids prescribed.



Results:

290 patients were included in the study. The mean MEUs administered intraoperatively was 25.1 (range 0 - 50). The mean MEUs provided in the recovery room was 2.9 (range 0-60). The mean MEUs prescribed on the day of surgery was 155.6 per prescription (range, 137-178 MEUs). A 155.6 MEU is equivalent to 35 pills of Tylenol #3 or 21 pills of oxycodone 5 mg. We used Pearson's correlation coefficient of r = 0 meaning no/weak correlation and r = 1 meaning a strong correlation. Neither MEUs provided intraoperatively or in recovery, nor MEUs prescribed postoperatively correlated with prescriptions filled (r = 0.13, 0.02, 0.09, respectively). Although patients undergoing bony procedures were prescribed more opioids (p < 0.001), opioid consumption intraoperatively, in recovery, and prescriptions filled were not significantly different (p = 0.23, 0.64, 0.78 respectively).



Conclusions:

The MEUs administered and prescribed on the day of surgery did not affect the amount of prescriptions filled postoperatively. Finally, patients undergoing bony procedures were prescribed more opioids than patients undergoing soft tissue procedures, but they did not consume or fill more opioids postoperatively.


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