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American Association for Hand Surgery

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Defining Prolonged Opioid Use After Surgery - A Systematic Review and Proposed Criteria for Hand Surgery
Steven P. Moura, MA1, Showly Nicholson, BA2, Yannick Albert J. Hoftiezer, MD3, Jonathan Lans, MD, PhD2, Neal C. Chen, MD2 and Kyle R. Eberlin, MD4, (1)Massachusetts General Hospital / Boston University School of Medicine, Boston, MA, (2)Massachusetts General Hospital / Harvard Medical School, Boston, MA, (3)Massachusetts General Hospital, Boston, MA, (4)Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Massachusetts General Hospital / Harvard Medical School, Boston, MA

Introduction: Prolonged opioid use after surgery has been a contributing factor to the ongoing opioid epidemic. However, the level of consensus within and between surgical specialties on the definitions for this problem is unclear. The purpose of this systematic review is to analyze these definitions and propose criteria to define postoperative prolonged opioid use in hand surgery.
Materials and Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines, 5,085 studies on postoperative opioid use were screened and 130 studies were eligible for inclusion. The primary outcome was the timepoint used to define prolonged opioid use following surgery. The proportion of patients with prolonged use and risk factors for prolonged use were also collected for each study. Included studies were categorized based on their surgical specialty.
Results: The most common timepoint used to define prolonged opioid use was 3 months (n=86, 67.2% of eligible definitions), ranging from 1 to 24 months. While 11 out of 12 specialties had a mean timepoint between 2.5 and 4.17 months, Spine surgery was the only outlier with a mean of 6.90 months. No correlation was found between the timepoints of the definitions and the rates of prolonged opioid use. The most common risk factors for prolonged opioid use after surgery were preoperative opioid use (48.5% of studies) and mood disorders (26.9%).
Conclusions:

  • A vast majority of studies use 3 months as the timepoint to define prolonged opioid use after surgery, regardless of the surgical procedure.
  • The authors suggest that procedure-specific definitions will be useful in clinical practice and for research purposes.
  • Therefore, we propose criteria to define prolonged opioid use in hand surgery, divided into four separate categories.
  • These are;
    • Two weeks for minor soft tissue procedures (e.g. trigger finger release, flexor tendon repair);
    • One month for major soft tissue procedures (e.g. skin grafts and flap coverage);
    • One month for minor bone procedures (e.g. ORIF or closed pinning of metacarpal and phalangeal fractures, CMC arthroplasty);
    • Six weeks for major bone procedures (e.g. corrective osteotomy, major limb amputation).



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