Prolonged Opioid Use After Surgery for Distal Radius Fracture: Who is at Risk?
William O Runge, MD1, Matthew Broggi, MD, MBA1, Alex Dawes, BS2, Roy Toston, BS3, John T Hurt, BS1, Eric R. Wagner, MD1 and Michael Gottschalk, MD4, (1)Emory University, Atlanta, GA, (2)Emory University School of Medicine, Atlanta, GA, (3)Emory University School Medicine, Atlanta, GA, (4)Orthopedic Surgery, Emory School of Medicine, Atlanta, GA
INTRODUCTION: Distal radius fractures are a common surgically treated orthopaedic injury typically requiring opioid pain medication postoperatively. In this study we investigate risk factors for opioid refills after distal radius fracture repair, and hypothesize that factors such as alcohol/tobacco abuse, depression, and diabetes will increase the risk of additional refills.
METHODS: Using Truven Marketscan® database, all patients who underwent open reduction internal fixation (ORIF) of distal radius fracture were identified using Common Procedural Terminology (CPT) codes. Opioid use data was collected using National Drug Codes (NDC) outpatient pharmacy claims. Patients with preoperative opioid use were excluded from the study, and those remaining were sorted into three cohorts based on postoperative opioid use: 1) Patients with no additional opioid refills 2) Patients receiving at least one opioid refill up to six months postoperatively 3) Patients with refills and continued opioid use past six months. One-way ANOVA with post-hoc comparison and multivariate regression were run for statistical analysis. Odds ratios with 95% confidence intervals were calculated for variables with p value <0.05.
RESULTS: 34,629 opioid-naïve patients were included. 25,427 (73.4%) required no refill, 6,992 (20.2%) had an additional prescription within six months, and 2,210 (6.4%) had prolonged opioid use after six months. The prolonged use group was initially prescribed an average of 34.6 more pills than the no-refill group, and 11 pills more than the refill group (p<0.001). Patients over 65 had significantly lower risk of needing opioids at the six-month and one-year marks (OR 0.74, OR 0.77). Female gender carried less risk of opioid use at six months (OR 0.91). At six months and one year respectively, opioid use increased with comorbidities including obesity (OR 1.22, 1.24), alcohol abuse (OR 1.44, 1.83), tobacco use (OR 1.63, 1.78), and depression (OR 1.22, 1.75). Also at risk in these intervals were patients with ED visits (OR 1.61, 1.75) or readmission (OR 1.92, 2.41), as well as those with complications like acute infection (OR 1.59, 1.97), wound complication (OR 1.73, 1.74), and hardware complication (OR 5.32, 5.77).
CONCLUSION: In this study, we found a dose-dependent relationship between original postoperative opioid prescription and number of additional refills, which mirrors literature indicating over prescription may lead to prolonged dependency. Demographic factors and comorbidities including obesity, alcohol abuse, tobacco use, and depression increased odds of requiring additional refills. Surgical complications including infection, wound complication, and hardware complication, increased the risk for prolonged opioid use.
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