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Post-Operative Pain Medication Effects on Patient-Reported Outcomes within 3 Months of Distal Radius Fracture Fixation
Rebekah M Kleinsmith, MD1, Stephen A Doxey, DO1, Deborah C Bohn, MD2 and Brian P Cunningham, MD3, (1)TRIA Orthopedic Center, Bloomington, MN, (2)Orthopaedics, University of Minnesota, Minneapolis, MN, (3)Park Nicollet Methodist Hospital, Minneapolis, MN

The opioid epidemic in the United States has led to drug overdose being the number one cause of accidental death in the United States, with nearly 80% of opioid users starting off on prescription medications. Orthopaedic surgeons are the third highest prescribers of opioid medications in the United States. The purpose of this study is to analyze the effect of post-operative pain medications on patient-reported wrist/hand evaluation (PRWHE) outcomes at 6 weeks and 3 months after DRF fixation.
A retrospective review of 157 patients was performed for this study. Exclusion criteria were age less than 18 years, polytrauma, and concomitant procedure. Patient demographics and surgical characteristics were pulled from the electronic medical record (EMR). Patient-reported outcomes were prospectively collected at baseline, and at 6 weeks, and 3 months after surgery and retrospectively evaluated. These were stored in a HIPAA-compliant electronic database. Morphine milligram equivalents (MME) were calculated using a conversion table published by the CDC. Minimum clinically important difference (MCID) was calculated using an anchor-based method.
A total of 157 patients met inclusion criteria for this study. The majority were women (132, 84.1%). The average age was 59.0 ± 14.3, and the average BMI was 27.8 ± 6.4. The average MME prescribed at discharge was 196.0 ± 139.2. Patients in bottom quartile of discharge MME prescribed had significantly better PRWHE scores than their counterparts in the highest quartile of MME prescribed at 6 weeks (29.6 ± 17.5 vs. 40.7 ± 20.3; p = 0.010) and 3 months (17.8 ± 13.0 vs. 30.6 ± 23.6; p = 0.013) (Figure 1). There was no difference in average discharge MMEs prescribed between patients that met MCID at 6 weeks or 3 months (p=0.984 and p=0.173 respectively).
This retrospective review of 157 patients after operative DRF management revealed no correlation between post-operative PROMs at 6 weeks and 3 months and MME. A standardized postoperative prescription regimen would limit variability of discharge MMEs while maintaining PROs. Based on the data demonstrated in this study, the first postoperative prescription for pain medication should not exceed 100MME.

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