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Predictors of adequate pain control after outpatient hand and upper extremity surgery

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

Abstract

Purpose

The opioid epidemic has changed practice, though there remains a paucity of data regarding prescribing habits and pain control following outpatient hand surgery. We sought to evaluate patient-related predictors of adequate postoperative pain control.

Methods

A retrospective review was performed of a single-center prospectively collected database of elective outpatient surgery on the elbow, forearm, wrist, and/or hand. Patients were asked to complete preoperative and postoperative questionnaires to capture their perception of anticipated pain levels, expected prescription quantity/duration, additional medications used, and overall pain satisfaction. Patient demographics collected included, sex, age, race, tobacco use, and recreational drug use. Further, the questionnaire included the Brief Resilience Score (BRS), EuroQol 5-dimension health-related QOL measure (EQ-5D), and an assessment of patient-reported limitations secondary to their pain.

Results

Ninety-six patients completed the pre/postoperative questionnaires and were eligible for analysis. Of these patients, 80% reported adequate pain control. The sex, age, and race of those who reported adequate pain control and inadequate control were not significantly different. BRS scores were not found to be significantly different between groups, although EQ-5D QOL scores were significantly lower in the inadequately controlled group. Tobacco use was more prevalent in the inadequately controlled group. Marijuana use and the presence of a chronic pain diagnosis were not significantly different between groups.

Conclusion

Preoperative self-reported quality of life measures and tobacco use appear to have significant effects on postoperative opioid use, suggesting further areas of optimization which may ensure patients are safe and minimize the number of opioid pills required.

Level of evidence IV.

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References

  1. Sabatino MJ, Kunkel ST, Ramkumar DB et al (2018) Excess opioid medication and variation in prescribing patterns following common orthopaedic procedures. J Bone Jt Surg 100:180–188. https://doi.org/10.2106/JBJS.17.00672

    Article  Google Scholar 

  2. Morris BJ, Mir HR (2015) The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg 23:267–271. https://doi.org/10.5435/JAAOS-D-14-00163

    Article  PubMed  Google Scholar 

  3. Secrist E, Wally MK, McKnight R et al (2020) Opioid prescribing and patient satisfaction scores across practice types. J Surg Orthop Adv 29:5–9

    PubMed  Google Scholar 

  4. Abuse NI (2023) Drug overdose death rates. National Institute Drug Abuse. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates. Accessed 20 Jun 2023

  5. Roehler D, Hoots B, Olsen EO, et al (2019) Annual surveillance report of drug-related risks and outcomes—United States, 2019. Doi: https://doi.org/10.13140/RG.2.2.17714.76481.

  6. Jones CM, Logan J, Gladden RM, Bohm MK (2015) Vital signs: demographic and substance use trends among heroin users—United States, 2002–2013. MMWR Morb Mortal Wkly Rep 64:719–725

    PubMed  PubMed Central  Google Scholar 

  7. Lin DH, Lucas E, Murimi IB et al (2017) Physician attitudes and experiences with Maryland’s prescription drug monitoring program (PDMP): physician experiences with PDMPs. Addiction 112:311–319. https://doi.org/10.1111/add.13620

    Article  PubMed  Google Scholar 

  8. Volkow ND (2011) Characteristics of opioid prescriptions in 2009. JAMA 305:1299. https://doi.org/10.1001/jama.2011.401

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Elkassabany NM, Wang A, Ochroch J et al (2019) improved quality of recovery from ambulatory shoulder surgery after implementation of a multimodal perioperative pain management protocol. Pain Med 20:1012–1019. https://doi.org/10.1093/pm/pny152

    Article  PubMed  Google Scholar 

  10. McLaren S, Sims L, Cheng Y et al (2021) The effects of patient resilience and catastrophizing on carpal tunnel surgical outcomes. J Hand Surg Glob Online 3:322–328. https://doi.org/10.1016/j.jhsg.2021.07.006

    Article  PubMed  PubMed Central  Google Scholar 

  11. Smith BW, Dalen J, Wiggins K et al (2008) The brief resilience scale: assessing the ability to bounce back. Int J Behav Med 15:194–200. https://doi.org/10.1080/10705500802222972

    Article  PubMed  Google Scholar 

  12. Grobet C, Marks M, Tecklenburg L, Audigé L (2018) Application and measurement properties of EQ-5D to measure quality of life in patients with upper extremity orthopaedic disorders: a systematic literature review. Arch Orthop Trauma Surg 138:953–961. https://doi.org/10.1007/s00402-018-2933-x

    Article  PubMed  Google Scholar 

  13. The EuroQol Group (1990) EuroQol—a new facility for the measurement of health-related quality of life. Health Policy 16:199–208. https://doi.org/10.1016/0168-8510(90)90421-9

    Article  Google Scholar 

  14. Ware JE, Kosinski M, Keller SD (1996) A 12-item short-form health survey: construction of scales and preliminary tests of reliability and validity. Med Care 34:220–233. https://doi.org/10.1097/00005650-199603000-00003

    Article  PubMed  Google Scholar 

  15. Maempel JF, Jenkins PJ, McEachan JE (2020) The relationship of mental health status to functional outcome and satisfaction after carpal tunnel release. J Hand Surg Eur 45:147–152. https://doi.org/10.1177/1753193419866400

    Article  Google Scholar 

  16. Dwyer CL, Soong M, Hunter A et al (2018) prospective evaluation of an opioid reduction protocol in hand surgery. J Hand Surg 43:516-522.e1. https://doi.org/10.1016/j.jhsa.2018.01.021

    Article  Google Scholar 

  17. Kim N, Matzon JL, Abboudi J et al (2016) A prospective evaluation of opioid utilization after upper-extremity surgical procedures: identifying consumption patterns and determining prescribing guidelines. J Bone Jt Surg 98:e89. https://doi.org/10.2106/JBJS.15.00614

    Article  Google Scholar 

  18. Sacks HA, Stepan JG, Wessel LE, Fufa DT (2019) The relationship between pain-related psychological factors and postoperative opioid use after ambulatory hand surgery. J Hand Surg 44:570–576. https://doi.org/10.1016/j.jhsa.2019.01.010

    Article  Google Scholar 

  19. Stanek JJ, Renslow MA, Kalliainen LK (2015) the effect of an educational program on opioid prescription patterns in hand surgery: a quality improvement program. J Hand Surg 40:341–346. https://doi.org/10.1016/j.jhsa.2014.10.054

    Article  Google Scholar 

  20. Bot AGJ, Bekkers S, Arnstein PM et al (2014) Opioid use after fracture surgery correlates with pain intensity and satisfaction with pain relief. Clin Orthop 472:2542–2549. https://doi.org/10.1007/s11999-014-3660-4

    Article  PubMed  PubMed Central  Google Scholar 

  21. Townsend CB, Ly JA, Judy R et al (2022) Larger perioperative opioid prescriptions lead to prolonged opioid use after hand and upper extremity surgery: a multicenter analysis. JAAOS Glob Res Rev. https://doi.org/10.5435/JAAOSGlobal-D-22-00036

    Article  Google Scholar 

  22. Gaddis A, Dowlati E, Apel PJ et al (2019) Effect of prescription size on opioid use and patient satisfaction after minor hand surgery: a randomized clinical trial. Ann Surg 270:976–982. https://doi.org/10.1097/SLA.0000000000003127

    Article  PubMed  Google Scholar 

  23. Johnson SP, Chung KC, Zhong L et al (2016) Risk of prolonged opioid use among opioid-naïve patients following common hand surgery procedures. J Hand Surg 41:947-957.e3. https://doi.org/10.1016/j.jhsa.2016.07.113

    Article  Google Scholar 

  24. Klifto KM, Yesantharao PS, Dellon AL et al (2021) Chronic neuropathic pain following hand burns: etiology, treatment, and long-term outcomes. J Hand Surg 46:67.e1-67.e9. https://doi.org/10.1016/j.jhsa.2020.07.001

    Article  Google Scholar 

  25. Kaneko A, Naito K, Obata H et al (2022) Influence of smoking in the clinical outcomes of distal radius fractures. J Hand Microsurg 14:212–215. https://doi.org/10.1055/s-0040-1715425

    Article  PubMed  Google Scholar 

  26. Morissette SB, Tull MT, Gulliver SB et al (2007) Anxiety, anxiety disorders, tobacco use, and nicotine: a critical review of interrelationships. Psychol Bull 133:245–272. https://doi.org/10.1037/0033-2909.133.2.245

    Article  PubMed  Google Scholar 

  27. Tadesse M, Ahmed S, Regassa T et al (2022) Effect of preoperative anxiety on postoperative pain on patients undergoing elective surgery: prospective cohort study. Ann Med Surg. https://doi.org/10.1016/j.amsu.2021.103190

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery and Sports Medicine, University of Florida, 3450 Hull Road, Gainesville, FL, 32611, USA

    Colin Swigler, Keegan M. Hones, Joseph J. King, Thomas W. Wright, Aimee M. Struk & Robert C. Matthias

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  1. Colin Swigler
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  2. Keegan M. Hones
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  3. Joseph J. King
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  6. Robert C. Matthias
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Corresponding author

Correspondence to Joseph J. King.

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Conflicts of interest

This study received no funding. Dr. King is a consultant for Exactech, Inc. and LinkBio Corp. Dr. Wright is a consultant for and receives royalties from Exactech, Inc. The other authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

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Swigler, C., Hones, K.M., King, J.J. et al. Predictors of adequate pain control after outpatient hand and upper extremity surgery. Eur J Orthop Surg Traumatol 34, 1543–1549 (2024). https://doi.org/10.1007/s00590-024-03836-7

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  • DOI: https://doi.org/10.1007/s00590-024-03836-7

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