Patterns of Opioid Prescribing for an Orthopaedic Trauma Population

OBJECTIVES:To determine opioid-prescribing practices to the orthopaedic trauma (OT) population at one Level I trauma center. DESIGN:A retrospective study of discharge prescriptions for adult patients with OT. Prescription details, injury burden, and patient demographics were abstracted for patients...

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Bibliographic Details
Published in:	Journal of orthopaedic trauma Vol. 31; no. 6; pp. e179 - e185
Main Authors:	Ruder, John, Wally, Meghan K, Oliverio, McKell, Seymour, Rachel B, Hsu, Joseph R
Format:	Journal Article
Language:	English
Published:	United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-06-2017
Subjects:	Adolescent Adult Aged Aged, 80 and over Analgesics, Opioid - therapeutic use Drug Prescriptions - statistics & numerical data Drug Utilization - statistics & numerical data Drug Utilization Review Female Humans Male Medical Overuse - statistics & numerical data Middle Aged North Carolina - epidemiology Orthopedic Procedures - statistics & numerical data Pain, Postoperative - epidemiology Pain, Postoperative - prevention & control Practice Patterns, Physicians' - statistics & numerical data Prevalence Young Adult
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Summary:	OBJECTIVES:To determine opioid-prescribing practices to the orthopaedic trauma (OT) population at one Level I trauma center. DESIGN:A retrospective study of discharge prescriptions for adult patients with OT. Prescription details, injury burden, and patient demographics were abstracted for patients from initial injury through a 2-month follow-up. SETTING:Level I trauma center. PATIENTS/PARTICIPANTS:Adult patients with OT admitted over a 30-day period (n = 110). INTERVENTION:All discharge and follow-up opioid prescriptions were recorded. MAIN OUTCOME MEASUREMENTS:Morphine milligram equivalents (MMEs) per day, number of opioid prescriptions, type/dose of medication prescribed. RESULTS:One hundred thirty-five discharge prescriptions were written for 110 patients with orthopaedic injuries during the review period. All patients received opioids at the time of discharge. The MMEs prescribed at the time of discharge was 114 mg (54–300 mg) for a mean of 7.21 days (2–36.7 days). Although patients with preinjury risk factors were prescribed discharge opioids for a similar duration (7.00 days vs. 7.30 days, P = 0.81) than those without risk factors, they were prescribed significantly more MMEs than those without (130 vs. 108, P < 0.05) and were more likely to receive extended-release and long-acting opioids than those without (42.11% vs. 21.98%). CONCLUSIONS:Pain management after OT continues to be opioid-centric despite involving a population at risk. Further focus on prescriber and patient education, risk evaluation with mitigation, guideline development, and comprehensive pain management strategies are warranted in the OT population. LEVEL OF EVIDENCE:Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 A list of contributors can be found in an Acknowledgment at the end of the article.
ISSN:	0890-5339 1531-2291
DOI:	10.1097/BOT.0000000000000834