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American Association for Hand Surgery

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Nonsurgical Providers Provide the Majority of Postoperative Opioid Prescriptions After Hand Surgery
Madeline Tadley, MD1, Clay Townsend, MD2, Shivangi Bhatt, BS3, Monica Morgenstern, MS3, Kevin F Lutsky, MD4 and Pedro K Beredjiklian, M.D.5, (1)Rothman Orthopaedic Institute at Thomas Jefferson, Philadelphia, PA, (2)Rothman Institute at Thomas Jefferson University Hopsital, Philadelphia, PA, (3)Drexel University College of Medicine, Philadelphia, PA, (4)Rothman Institute, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, (5)Rothman Institute, Philadelphia, PA

Introduction
The increased use of Prescription Drug Monitoring Program (PDMP) websites has helped physicians to limit overlapping controlled substance prescriptions and help prevent opioid abuse. Many studies have investigated risk factors for prolonged opioid use after orthopaedic surgery, but few studies have investigated who is prescribing opioids to postoperative patients. The purpose of this study is to investigate the types of medical providers prescribing opioids to hand surgery patients postoperatively.
Materials and Methods
Institutional Review Board approval was obtained prior to initiation of this study. An institutional database search was performed to identify all patients ≥18 years old that underwent a single hand surgery at our institution from 7/31/2018-3/15/2019. A search of the state PDMP website was performed to identify opioid prescriptions filled by these hand surgery patients from 6 months preoperatively to 12 months postoperatively. Prescribers were classified into several groups: 1) the patient's operating surgeon, 2) other orthopaedic surgery providers, 3) general medicine providers (internal medicine, primary care, family medicine, and adult health providers), and 4) all other medical providers.
Results
327 patients could be identified in the PDMP database and received an opioid prescription on the day of surgery. Of these, 108 (33.0%) filled a total of 341 additional opioid prescriptions postoperatively. Non-orthopaedic providers prescribed 81.5% of all opioid prescriptions within 12 months postoperatively, with the patient's operating surgeon prescribing only 10% of all prescriptions. General medicine providers were the highest prescriber group at 28.7% of total postoperative opioid prescriptions. From 6-12 months postoperatively, the patient's operating surgeon prescribed only 4.9% of total opioid prescriptions filled, which decreased significantly compared to the percentage within 1 month postoperatively. (p<.05) (Figure 1) The patient's operating surgeon prescribed significantly smaller average opioid prescriptions in total MMEs compared to all other provider groups. (p<.05)
Conclusions
Surgeons should be aware that their surgical patients may be receiving opioid prescriptions from a wide variety of medical providers postoperatively, and that these other providers may be prescribing larger prescriptions. The findings of this study emphasize the importance of collaboration across medical specialties to mitigate the risks of prolonged opioid use after hand surgery.


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