Opioid Prescribing Practices after Thumb Carpometacarpal Arthroplasty: Patterns, Trends, and Risk Factors for Additional Refills
Brianna L Siracuse, MD1, Alex Dawes, BS2, Corey C Spencer, MD2, John T Hurt, BS1, Roy Toston, BS3, Michael Gottschalk, MD4 and Eric R. Wagner, MD1, (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: Despite perception that thumb carpometacarpal (CMC) arthroplasty is one of the most painful hand surgeries, there is limited literature assessing utilization of opioids postoperatively. This study aimed to identify opioid prescription patterns and risk factors associated with need for opioid prescription refills after CMC arthroplasty.
METHODS: Using Truven Marketscan database, all patients who underwent CMC arthroplasty from 2010 to 2016 were identified via CPT codes and included if continually enrolled in the database for 1 year pre- and postoperatively. Opioid data was collected using National Drug Codes from outpatient pharmacy claims and used to identify opioid naïve patients for inclusion. Refills were then defined as any prescription filled between 7 days and 6 months post-procedure. Descriptive statistical analysis was performed, and odds ratios were reported.
RESULTS: 20,731 total patients underwent CMC arthroplasty. 5,490 (26.48%) patients required an opioid refill, and 15,223 (73.43%) patients had no refill. Risk factors significantly associated with increased likelihood of dispensed refill were smoking (OR 1.18), diabetes (OR 1.18), depression (OR 1.13), and CMC steroid injection within six months preoperatively (OR 1.16). Those requiring a refill were prescribed an average of 47.8 pills (379.4 oral morphine milligram equivalents [OMEs]), compared to 28.0 (220.1 OMEs) for those not requiring a refill. Furthermore, there were significantly more opioid pills initially prescribed to patients from 2014 to 2016 compared to the group from 2010 to 2013 (M= 38.8 vs. M= 30.5, respectively).
CONCLUSION: Overall, 1 in 4 opioid naïve patients undergoing CMC arthroplasty required an opioid refill. Smoking, diabetes, depression, and steroid injections within 6 months preoperatively increased the risk of an additional refill. Additionally, patients who required an opioid refill were initially prescribed almost twice the number of pills. These findings highlight the potential role of patient factors and prescribing patterns on prolonged opioid use after CMC arthroplasty. We are hopeful this information will be utilized for both patient education and future trials attempting to reduce the number of opioids prescribed and refills required.
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