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An Assessment of Long-Term Opioid Use Following Tibial Plateau Fracture Repair

An At-Risk Patient Population Based on Race/Ethnicity

Radi, Joshua K. PhD, PA-C1,2,3; Curtis, Amy B. PhD, MPH4; DiSilvio, Frank Jr. BS, MS5; Vangsnes, Eric PhD, PA-C4; Byram, Scott MD5; Summers, Hobie MD5

JBJS Journal of Orthopaedics for Physician Assistants: July-September 2019 - Volume 7 - Issue 3 - p e0027
doi: 10.2106/JBJS.JOPA.18.00027
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Objectives: Is there a difference in percentage of opioid use at 3 and 6 months among different races/ethnicities following tibial plateau fracture repair after controlling for potential confounders?

Methods: Retrospective secondary data analysis of 18- to 65-year-old patients with operative tibial plateau fractures between 2006 and 2015 at a level-I trauma center. Exclusion criteria included preinjury opioid use or history of opioid dependence, American Society of Anesthesiologists class ≥3, renal or lower extremity neurological impairment, and/or rheumatoid arthritis. Three hundred fifteen operative tibial plateau fractures were identified and, following application of our exclusion criteria, final sample size was 211. Intervention included single-shot peripheral nerve block (PNB) vs. no PNB. Main outcome measurements were opioid use at 3 or 6 months compared among all race/ethnicities.

Results: Black patients were less likely to be on prescription opioids than whites at both 3 months (p = 0.015, odds ratio [OR] = 0.396 [0.188 to 0.835]) and 6 months (p = 0.027, OR = 0.239 [0.067 to 0.852]). Hispanic patients did not differ statistically from white patients in having an opioid prescription at 3 or 6 months. Smokers were independently more likely to be on prescription opioids than nonsmokers at 6 months (p = 0.013, OR = 2.874 [1.245 to 6.635]).

Conclusions: Disparities exist with regard to opioid use among white and black patients following lower extremity surgery, regardless of PNB status. White patients are at risk for long-term opioid use following tibial plateau fracture repair and black patients may not be receiving adequate pain control postoperatively. Smoking was found to be associated with long-term opioid use.

193rd WMD-CST (Weapons of Mass Destruction-Civil Support Team), Hawaii Army National Guard, Kapolei, Hawaii

2Department of Orthopaedic Surgery, Tripler Army Medical Center, Honolulu, Hawaii

3Department of Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii

4Interdisciplinary Health Sciences PhD Program (A.B.C.), Health Data Research, Analysis and Mapping Center (A.B.C.), and Physician Assistant Program (E.V.), College of Health and Human Services, Western Michigan University, Kalamazoo, Michigan

5Loyola University Chicago Stritch School of Medicine (F.D.), Acute Pain Service (S.B.), Department of Orthopaedic Surgery (H.S.), Loyola University Medical Center, Maywood, Illinois

Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSJOPA/A76).

Disclaimer: The views expressed in this abstract/manuscript are those of the author(s) and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government. Funding streams had no involvement with theme analysis or the intellectual production of this research.

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated.
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