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Abstract
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BACKGROUND: Patients undergoing upper extremity fracture surgery often have postoperative pain that can be mitigated with opioid pain medications. Opioid misuse and abuse are growing concerns regarding the liberal use of opioids in the perioperative setting. The impact of mental health disorders and substance abuse on perioperative opioid demand is largely unknown. The purpose of this study is to describe perioperative opioid filling and risk factors for increased filling after upper extremity fractures. The study hypothesis is that poor mental health and substance abuse will be associated with increased opioid demand.
METHODS: This is a retrospective, cohort study of 26,283 patients undergoing operative fixation of upper extremity fractures involving the proximal humerus through distal radius using a commercially-available insurance database. Opioid prescription filling in oxycodone 5-mg equivalents and refills were tabulated from 1-month preoperative to 1-year postoperative. Multivariable linear and logistic regression models were constructed in R (Statistical Analysis Software) to evaluate associations between mental health and substance use disorders and opioid-related outcomes with adjustment for baseline patient and treatment factors such as age, sex, comorbidities, and fracture location.
RESULTS: Of the 26,283 patients in the cohort, 79.9%, 32.6%, and 83.1% filled at least one opioid prescription in the 1-month preop to 90-days postop, 3-months postop to 1-year postop, and 1-month preop to 1-year postop timeframes, respectively. Mean opioid volume prescribed during those timeframes was 103.7, 53.5, and 156.9 oxycodone 5-mg equivalents, respectively. Drug abuse, psychoses, and preoperative opioid filling were significant mental health-related drivers of increased postoperative opioid demand.
DISCUSSION: This study reports the rate and volume of opioid prescription filling in patients undergoing upper extremity fracture surgery. Mental health and substance use disorders were significant drivers of perioperative opioid demand. These study findings can guide surgeons to anticipate expected perioperative opioid demand and identify patients who may benefit from collaboration with pain management specialists during the perioperative period.
Language: en |