Complications and Prolonged Postoperative Opioid Use in Four Corner Arthrodesis and Proximal Row Carpectomy
Neill Yun Li, MD1, Alexander S Kuczmarski, BS, MS2, Andrew Hresko, BA3, Avi Goodman, MD4, Joseph Gil, MD1 and Alan H Daniels, MD5, (1)Brown University, Providence, RI, (2)Warren Alpert Medical School of Brown University, Providence, RI, (3)Tufts University, Boston, MA, (4)Alpert Medical School of Brown University, Providence, RI, (5)Brown University, Warren Alpert Medical School, Providence, RI
Purpose: The purpose of this study was to use a national multi-payer database to identify patients undergoing four corner arthrodesis (FCA) or proximal row carpectomy (PRC) to determine postoperative opioid use and risk factors for and complications associated with prolonged postoperative opioid use.
Methods: The PearlDiver Research Program (www.pearldiverinc.com), containing Humana Inc. claims and Medicare files were used to identify undergoing FCA (CPT: 25820, 25825) and PRC (CPT: 25215) from 2007 to the first quarter of 2017. Pre-existing comorbidities were identified with ICD-9, ICD-10 diagnosis codes. Preoperative opioid use was determined using opioid drug codes within three months prior to surgery. Complications were defined by ICD-9, ICD-10 diagnosis codes, conversion to wrist arthrodesis was defined by CPT (25800, 25805, 25810). Prolonged postoperative opioid use was three months from index procedure. A P value <0.05 was statistically significant.
Results: From 2007 through the first quarter of 2017, 888 patients underwent primary FCA and 835 patients underwent primary PRC. There were no significant differences in age, gender, race, pre-existing comorbidities, or preoperative opioid use between procedures (Table 1).
Following FCA, 160 patients (18.0%) had prolonged opioid use compared to 123 patients (14.7%) following PRC. After multivariable logistic regression FCA patients were significantly more likely to have prolonged opioid use than PRC patients (OR:1.33; 95% CI: 1.02-1.64; p=0.033). Patients with prolonged opioid use following FCA were significantly more likely to have pulmonary disease, peripheral vascular disease, and depression. Preoperative opioid use was the most significant risk factor for prolonged opioid use after FCA (OR: 4.91; 95% CI: 3.37-7.27; p<0.001) (Table 2).
For PRC, pre-existing tobacco use, alcohol abuse, depression, anxiolytic and muscle relaxant use, and fibromyalgia were significant risk factors for prolonged postoperative opioid use. Preoperative opioid use had the highest risk for prolonged postoperative opioid use following PRC (OR: 6.25; 95% CI: 4.01-10.55; p<0.001) (Table 3).
Patients with prolonged opioid use following FCA had a significantly greater risk of implant complications (OR: 4.96; 95% CI: 3.07-7.93; p<0.001) and conversion to TWA (OR: 3.45; 95% CI: 1.65-6.87; p<0.001) than patients without prolonged opioid use following FCA.
Conclusions: This national retrospective analysis finds FCA and PRC carry substantial risks of prolonged postoperative opioid use. This adds to movement for the development and implementation of multimodal pain regimens that limit reliance on opioids to curb prolonged use and dependence, especially after elective procedures or hand and upper extremity procedures.
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