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Reducing Disability Durations and Medical Costs for Patients With a Carpal Tunnel Release Surgery Through the Use of Opioid Prescribing Guidelines

Gaspar, Fraser W. PhD, MPH; Kownacki, Roman MD, MPH; Zaidel, Catherine S. MEM; Conlon, Craig F. MD, PhD; Hegmann, Kurt T. MD, MPH

Journal of Occupational and Environmental Medicine: December 2017 - Volume 59 - Issue 12 - p 1180–1187
doi: 10.1097/JOM.0000000000001168
Original Articles

Objective: The impacts of compliance with opioid prescribing guidelines on disability durations and medical costs for carpal tunnel release (CTR) were examined.

Methods: Using a dataset of insured US employees, opioid prescriptions for 7840 short-term disability cases with a CTR procedure were identified. Opioids prescriptions were compared with the American College of Occupational and Environmental Medicine (ACOEM)'s opioid prescribing guidelines for postoperative, acute pain, which recommends no more than a 5-day supply, a maximum morphine equivalent dose of 50 mg/day, and only short-acting opioids.

Results: Most cases (70%) were prescribed an opioid and 29% were prescribed an opioid contrary to ACOEM's guidelines. Cases prescribed an opioid contrary to guidelines had disability durations 1.9 days longer and medical costs $422 higher than cases prescribed an opioid according to guidelines.

Conclusions: The use of opioid prescribing guidelines may reduce CTR disability durations and medical costs.

Supplemental Digital Content is available in the text

ReedGroup, Ltd., Westminster, Colorado (Dr Gaspar, Ms Zaidel); Kaiser Permanente, Oakland, California (Dr Kownacki, Dr Conlon); and Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, Utah (Dr Hegmann).

Address correspondence to: Fraser W. Gaspar, PhD, MPH, 10355 Westmoor Drive, Westminster, CO. 80021 (

Funding Sources: Dr Gaspar and Ms Zaidel were funded by ReedGroup, Ltd. to perform the work in this manuscript. Dr Kownacki, Dr Conlon, and Dr Hegmann received no funding for this research.

Conflicts of Interest: Dr Gaspar and Ms Zaidel are ReedGroup, Ltd. employees. ReedGroup, Ltd. are the sole proprietors of the guidelines used in this study—the American College of Occupational and Environmental Medicine's (ACOEM) Practice Guidelines. Dr Hegmann is Editor of ACOEM's Guidelines. Dr Kownacki and Dr Conlon declare no conflicts of interest.

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This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Copyright © 2017 by the American College of Occupational and Environmental Medicine