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American Association for Hand Surgery

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Complication Rates Associated with Alternative Forms of Pain Relief Following Common Hand Surgeries
Mohammed Shaheen, JD, Stanford University Medical School, Stanford, CA and Catherine Curtin, MD, Stanford Hospital and Clinics, Palo Alto, CA

Introduction
Hand surgeons continue to have a dilemma with the use of opioids. Opioids provide reliable pain relief but have risks of dependence and diversion. There are emerging recommendations and evidence-based guidelines promoting strategies to reduce opioid use. Reluctance to adopt these strategies may in part be due to a perception that they may increase postoperative complications. We sought to determine (1) associations between such forms of pain management and postoperative complications and (2) annual trends in usage of different forms of pain management for common hand surgeries.
Methods
Using ICD/CPT codes, we identified adult patients (≥18 years old) who underwent elective or trauma-related hand surgery between 2010-2016 in the IBM MarketScan Research Databases. We stratified patients based on pain relief prescriptions filled 2 weeks before or up to 45 days after surgery (opioids only, non-opioids only, or multimodal analgesia (including opioids)). Complications (infections, dislocations, prosthetic complications, wound complications, joint derangement/contracture, and reoperations) occurring up to three months postoperatively were examined.
Results
416,807 elective surgery patients and 119,045 trauma-related surgery patients met inclusion criteria. Risk-adjusted multivariable logistic regression demonstrated that elective surgery patients who filled non-opioid (vs. opioid) prescriptions had no greater odds of complications overall (adjusted odds ratio [95% confidence intervals]): 0.96 [0.91-1.01]; Figure I). This remained consistent across all examined elective hand surgeries. Trauma-related surgery patients using multimodal analgesia (vs. opioids only) had no greater odds of complications overall (1.07 [0.99-1.15]; Figure I). Annual rate of "opioids only" patients increased steadily between 2010-2016; 2.5% to 6.7% for elective surgeries and 1.9% to 5.11% for trauma-related surgeries (p<0.0001; Figure II).
Conclusions
Postoperative pain management with non-opioids or multimodal analgesia (vs. opioids only) did not result in greater odds of postoperative complications in elective or trauma-related hand surgeries, respectively. However, the rate of opioid only pain management increased steadily during the study period (2010-2016). Since that time, there is a growing awareness among hand surgeons of the risks of opioids, and recent research has shown alternative pain management strategies provide adequate pain relief. This study augments the current literature by demonstrating that these alternatives do not generally increase postoperative complications.


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