Anatomic and procedure-specific guidelines may reduce overprescription of opioids
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Implementation of anatomic and procedure-specific opioid-prescribing guidelines may effectively reduce inadvertent overprescribing of opioids while maintaining patient satisfaction and minimizing refill demands among patients undergoing upper extremity surgery, according to results.
Asif M. Ilyas, MD, and colleagues postoperatively prescribed opioids based on published guidelines specific to the anatomic location and procedure type being performed on patients undergoing outpatient, upper extremity surgical procedures during a 6-month consecutive period. These guidelines consisted of patients receiving five opioid pills after soft tissue surgery and 10 opioid pills after fracture, arthritis or arthroscopic surgery. Researchers recorded surgical details, opioid consumption patterns and prescription efficacy and satisfaction at the first postoperative visit.
Results showed any amount of prescription use was reported by 201 patients, for a mean consumption of 5.5 pills.
“We found low opioid consumption with overall less opioids prescribed,” Ilyas told Healio Orthopedics. “Specifically, patients undergoing soft tissue procedures consumed the least (4.2 pills) compared to fracture repairs (6.7 pills) or arthroplasty/fusion procedures (8.7 pills).”
Patients undergoing hand procedures consumed 3.9 opioid pills compared with 6.3 opioid pills in wrist procedures and 8.1 pills in elbow procedures, according to results. Researchers noted 82% of patients who required opioids reported being satisfied or at least neutral to the prescribed quantity, while satisfaction or at least neutral feelings to the prescribed opioid analgesic efficacy was reported by 92% of patients. Results showed a study refill request rate of 13%.
“Based on our study findings, we recommend following anatomic and procedure-specific opioid-prescribing guidelines after upper extremity surgery to avoid inadvertent overprescribing while maintaining patient satisfaction and minimizing refill demands,” Ilyas said. – by Casey Tingle
Reference:
Adalbert JR, et al. ePaper 114. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
Disclosure: Ilyas reported he is a paid consultant for Acumed LLC, AxoGen and Globus Medical; is a paid presenter or speaker for DePuy; receives IP royalties from Globus Medical; receives publishing royalties, financial or material support from Jaypee Medical Publishers; and is a board or committee member for the PA Ortho Society.
Perspective
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Michael D. Wigton, MD
The ongoing opioid epidemic obligates all health care providers to do their part to stem its negative and lethal effects. Orthopedic surgeons have historically been a top prescriber of prescription opioids, namely hydrocodone. A majority of these prescriptions are provided for postoperative pain; many are unnecessary. The burden has fallen on us to do our part in eliminating unnecessary quantities of opioids pills thus lowering the overall distribution of opioid pills to society. Two factors often cited as concerns preventing orthopedic providers from adapting protocols with lower amounts of opioid pills are decreased patient satisfaction and the need for prescription refills.
In the abstract titled “Implementing prescribing guidelines for upper extremity orthopaedic procedures: A prospective analysis of postoperative opioid consumption and satisfaction,“ Jenna R. Adalbert, BS, and Asif M. Ilyas, MD, sought to allay these two concerns. In their prospective observational study, 201 patients received and utilized postoperative opioid prescriptions according to pre-established guidelines based on anatomic location and procedure type. At follow-up, 82% and 92% were satisfied or neutral to prescription amount and efficacy, respectively, and only 13% of patients required prescription refill. Thus, this prospective study provides evidence demonstrating that a protocol-driven postoperative opioid prescription program is effective at decreasing the number of pills prescribed while not adversely affecting satisfaction and efficacy.
Hand, upper extremity and microvascular surgery
University of Cincinnati College of Medicine
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Adalbert JR, et al. ePaper 114. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2020 (meeting canceled).
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