Preoperative Opioid Use Results in Increased Postoperative Opioid Use after Thumb Basal Joint Arthroplasty: A PDMP Analysis
Asif M Ilyas, MD, Orthopaedics, Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
INTRODUCTION: Thumb Basal Joint Arthroplasty (BJA) surgery is a common hand surgery requiring opioids postoperatively. In order to better understand safe opioid consumption patterns, an analysis was undertaken to identify risk factors for the need of a second postoperative prescription and/or prolonged opioid use (prescription filled over 6 months postop). We hypothesized that preoperative opioid use would show association with greater postoperative opioid use.
METHODS: We retrospectively reviewed all consecutive primary thumb BJA surgeries over a 1 year period who underwent surgery by the study surgeons and received and filled on opioid prescription postop. Demographics and clinical data were collected. Opioid prescription data was extracted from 6 months preop to 9 months postop using our state's Prescription Drug Monitoring Program (PDMP). All patients filled a first surgeon-provided opioid prescription postop. Bivariate and multivariate analyses were conducted for filling a second opioid prescription or prolonged use.
RESULTS: A total of 110 patients met inclusion criteria, with 26.4% filling an opioid prescription preop, 42% filling a second postop prescription, and 14.5% were found to still be consuming opioids greater than 6 months postop. Patients using preoperative opioids had 7-fold higher odds of filling a second opioid prescription and 37-fold odds of prolonged use. Demographics and clinical factors, including procedure type and initial surgeon-provided opioid prescription, did not show association. There were 25 patients with no opioid history who filled supplemental postoperative opioid prescriptions (p<0.005). Over 90% of supplemental opioids were not prescribed by the surgeon's office and included higher doses. The average initial postop opioid prescription was for 120 MME total, with an average of 36 MME per day. Postoperative prescriptions over 150 MME trended toward association with prolonged use.
CONCLUSION: Patients with opioid use within 6 months preop have a much greater odds of filling a second opioid prescription as well as prolonged opioid use (over 6 months) after primary thumb BJA. Postop follow-up time also showed association with greater opioid use, while other factors did not show association. The amount of opioids prescribed in the initial postop opioid prescription did not result in a secondary high refill rate indicating that a low initial dose can be considered. Lastly, nearly all opioid-naive patients that filled a second opioid prescriptions were from providers other than the surgeon.
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