SLR - August 2013 - Caitlin Garwood
Reference: Holman, Joel E., Gregory J Stoddard, and Thomas F. Higgins. Rates of Prescription Opiate Use Before and After Injury in Patients with Orthopaedic Trauma and the Risk Factors for Prolonged Opiate Use. Journal of Bone and Joint Surgery. 2013 June; 95-A(12): 1075-1080.
Scientific Literature Review
Reviewed By: Caitlin Garwood, DPM
Residency Program: Inova Fairfax Hospital, Falls Church, VA
Podiatric Relevance: Postoperative pain management can be a major problem for surgeons. There has been an increasing emphasis on appropriate pain control as well as monitoring narcotic usage. The foot and ankle surgeon treating trauma patients must find a balance between postoperative pain control and the risk of substance abuse in a population of patients with a high rate of substance abuse and dissatisfaction with pain management.
Methods: The Utah Controlled Substance Database was reviewed for all patients who were eighteen years of age or older who were managed operatively between June 2005 and June 2007 by the Utah Orthopaedic Trauma Service. The inclusion criteria limited the population to those with isolated musculoskeletal trauma requiring surgery only in the acute phase of their injury. Opiate usage was recorded for a three month preoperative period and a six month postoperative period.
Results: Inclusion criteria were met by 613 patients. Within three months preoperatively, 15.5 percent of the patients filled an opiate prescription. This is significantly higher than the 9.2 percent of the general population who filled a prescription in a three month period. In the postoperative period, 68.4 percent of patients filled opiate prescriptions for less than six weeks. Eleven-point-nine percent filled prescriptions between six and twelve weeks and 19.7 percent continued to fill opiate prescriptions for more than three months. Patients were six times as likely to continue opiate use past 12 weeks if they used more than one opiate prescription in the three months prior to injury. There was also a 3.5-fold increase in obtaining a prescription from a provider other than the surgeon if they obtained more than one prescription in the three months preoperatively. Lower extremity surgery required longer duration of opiate use than upper extremity surgery, but less than pelvic or acetabular surgery.
Conclusions: The use of opiates prior to undergoing orthopaedic trauma surgery significantly increases the duration of use postoperatively. It is also predictive of patients who will seek opiates from multiple providers. This information can be used for perioperative counseling on the use- and potential abuse- of opiates in trauma patients undergoing orthopaedic surgery.