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The effect of surgical pain severity, preoperative opioid use and patient characteristics on postoperative opioid prescriptions and refills in orthopedic surgery

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Background

Excessive opioid prescriptions after orthopedic surgery are common. The purpose of this study was to examine the association between surgical severity, preoperative opioid use and patient characteristics with postoperative opioid prescriptions and refills.

Methods

Seventy-nine patients undergoing orthopedic surgeries were reviewed. Surgical pain severity was categorized as mild (n = 25), moderate (n = 26) and severe (n = 28). Patients were also categorized as opioid naïve (n = 57), experienced (n = 16) and tolerant (n = 6). Postoperative and refill prescriptions were reviewed to determine morphine equivalent dose (MED) prescribed.

Results

Mild, moderate and severe pain surgeries received a median (interquartile range) equivalent of 20 (0, 30), 53 (33, 80) and 60 (45, 80) oxycodone 5 mg tablets, respectively. Excessive opioid prescriptions (> 400 MED) were given to 37 (46%) patients. There was no difference in the total discharge MED between moderate and severe pain surgeries or between opioid naïve and opioid-experienced patients (p > 0.05). Variables associated with excessive postoperative opioid prescriptions on multivariate analysis-included severe pain surgery (odds ratio 7.7, 95% confidence interval 2 to 25; p < 0.01) and anesthetic block (odds ratio 4.5, 95% confidence interval 1.4 to 14; p < 0.01). Variables associated with opioid refill on multivariate analysis included an American Society of Anesthiologists Physical Status (ASA) score > I (odds ratio 11, 95% confidence interval: 1.3 to 92; p < 0.01) and preoperative pain VAS (odds ratio 1.2, 95% confidence interval 1.01 to 1.4; p = 0.02).

Conclusion

The adoption of opioid prescription guidelines is warranted to differentiate between surgical severities and decrease the range and size of postoperative opioid prescriptions.

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Acknowledgements

Special thanks to Joshua King and Carrie Cherney for their assistance in data collection.

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Authors and Affiliations

  1. Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, 777 Bannock St MC 0188, Denver, CO, 80204, USA

    Johnna Jaynstein, Ashley Donnell, Lori Chambers, Cyril Mauffrey & Joshua A. Parry

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  1. Johnna Jaynstein
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  2. Ashley Donnell
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  3. Lori Chambers
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  4. Cyril Mauffrey
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  5. Joshua A. Parry
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Correspondence to Joshua A. Parry.

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Jaynstein, J., Donnell, A., Chambers, L. et al. The effect of surgical pain severity, preoperative opioid use and patient characteristics on postoperative opioid prescriptions and refills in orthopedic surgery. Eur J Orthop Surg Traumatol 30, 781–787 (2020). https://doi.org/10.1007/s00590-020-02628-z

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  • DOI: https://doi.org/10.1007/s00590-020-02628-z

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