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The Use of Opioid Analgesics following Common Upper Extremity Surgical Procedures

A National, Population-Based Study

Waljee, Jennifer F., M.D., M.S.; Zhong, Lin, M.S.; Hou, Hechuan, M.S.; Sears, Erika, M.D., M.S.; Brummett, Chad, M.D.; Chung, Kevin C., M.D., M.S.

Plastic and Reconstructive Surgery: February 2016 - Volume 137 - Issue 2 - p 355e–364e
doi: 10.1097/01.prs.0000475788.52446.7b
Hand/Peripheral Nerve: Original Articles
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Background: The misuse of opioid analgesics is a major public health concern, and guidelines regarding postoperative opioid use are sparse. The authors examined the use of opioids following outpatient upper extremity procedures to discern the variation by procedure type and patient factors.

Methods: The authors studied opioid prescriptions among 296,452 adults older than 18 years who underwent carpal tunnel release, trigger finger release, cubital tunnel release, or thumb carpometacarpal arthroplasty from 2009 to 2013 using insurance claims drawn from the Truven Health MarketScan Commercial Claims and Encounters, which encompasses over 100 health plans in the United States. Using multivariable regression, the authors compared the receipt of opioids, number of days supplied, indicators of inappropriate prescriptions, and number of refills by patient factors.

Results: In this cohort, 59 percent filled a postoperative prescription for opioid medication, and 8.8 percent of patients had an indicator of inappropriate prescribing. The probability of filling an opioid prescription declined linearly with advancing age. On multivariate analysis, patients who had previously received opioids were more likely to fill a postoperative opioid prescription (66 percent versus 59 percent), receive longer prescriptions (24 versus 5 days), receive refills following surgery (24 percent versus 5 percent), and have at least one indicator of potentially inappropriate prescribing (19 percent versus 6 percent).

Conclusions: Current opioid users are more likely to require postoperative opioid analgesics for routine procedures and more likely to receive inappropriate prescriptions. More evidence is needed to identify patients who derive the greatest benefit from opioids to curb opioid prescriptions when alternative analgesics may be equally effective and available.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Ann Arbor, Mich.

From the Section of Plastic Surgery, Department of Surgery, and the Department of Anesthesia, University of Michigan Health System.

Received for publication May 15, 2015; accepted September 21, 2015.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

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Jennifer F. Waljee, M.D., M.S., Section of Plastic Surgery, University of Michigan Health System, 2130 Taubman Center, SPC 5340, 1500 East Medical Center Drive, Ann Arbor, Mich. 48109-5340, filip@med.umich.edu

©2016American Society of Plastic Surgeons