Research: Research Article

Notable Variability in Opioid-prescribing Practices After Common Orthopaedic Procedures

Traven, Sophia A. MD; Brinton, Daniel L. PhD; Woolf, Shane K. MD; Leddy, Lee R. MD; Gottschalk, Michael B. MD; Slone, Harris S. MD

Author Information

From the Department of Orthopaedics and Physical Medicine, the Medical University of South Carolina, Charleston, SC (Dr. Traven, Dr. Brinton, Dr. Woolf, Dr. Leddy, Dr. Slone), and the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA (Dr. Gottschalk).

Correspondence to Dr. Traven: [email protected]

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Traven, Dr. Brinton, Dr. Woolf, Dr. Leddy, Dr. Gottschalk, and Dr. Slone.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Website (www.jaaos.org).

This is a non-human subjects' study.

Journal of the American Academy of Orthopaedic Surgeons 29(5):p 219-226, March 1, 2021. | DOI: 10.5435/JAAOS-D-19-00798

SDC

Abstract

Introduction:

The purpose of this study was to evaluate nationwide trends and regional variability in opioid prescriptions after common orthopaedic procedures.

Methods:

A retrospective analysis of privately insured subjects from the MarketScan database between 2015 and 2016 was conducted. Median oral morphine equivalents and interquartile ranges were analyzed by region for the initial post-op prescriptions and 90-day total prescriptions for opioid-naive patients undergoing the following: carpal tunnel release; anterior cruciate ligament reconstruction; arthroscopic meniscectomy; bimalleolar ankle fracture open reduction and internal fixation; distal radius fracture open reduction and internal fixation; arthroscopic rotator cuff repair; single-level anterior cervical discectomy and fusion; and total shoulder, hip, and knee arthroplasties. We hypothesized that notable regional variability exists with postoperative narcotic prescribing habits.

Results:

Seventy three thousand nine hundred twenty-one opioid-naive patients were identified. A notable regional variability was observed across the United States in the prescriptions given for all procedures, except total joint arthroplasty. Furthermore, although patients undergoing soft-tissue–only procedures required the fewest refills, patients undergoing total joint arthroplasty required the most.

Discussion:

Notable regional variability exisits in opioid prescribing patterns for many common orthopaedic procedures. Furthermore, prescriptions were smallest in the region most affected by the opioid epidemic. This information can be used to re-evaluate recommendations, serve as a benchmark for surgeons, and develop institutional and quality improvement guidelines to reduce excess postoperative opioid prescriptions.