Preop opioid use predicts pain med overprescription in hand surgery patients


Patients having orthopedic hand surgery and a history of opioid use were more likely to require postoperative opioid analgesics and to receive inappropriate prescriptions, according to Dr. Jennifer F. Waljee and her associates.

Out of 296,452 patients, 58.5% (n = 135,869) filled a prescription for opioid analgesics in the postoperative period (2009-2013). About 8.8% of users had at least one indicator of potentially inappropriate prescribing, most commonly with daily doses of 100-mg morphine equivalents or higher (6.9%). In a multivariable analysis, preoperative opioid exposure was the strongest predictor of overlapping opioid prescriptions (odds ratio, 18.4), overlap of opioid and benzodiazepine prescriptions (OR, 20.2), and high daily opioid doses (OR, 2.1).

The study examined patients who underwent carpal tunnel release, cubital tunnel release, surgical treatment for thumb carpometacarpal joint arthritis, and trigger finger release. Opioid use, the patients’ age, and refills on the opioid were also looked at during the study.

“Our findings underscore the importance of identifying patients who may be at risk of poor pain control preoperatively to avoid inappropriate, and potentially dangerous, prescribing practices following surgery,” researchers concluded. “Future studies that examine the provider-level factors that are associated with opioid prescribing may inform interventions that target clinician education and prescribing guidelines for postoperative opioid use.”

Read the full study in Plastic and Reconstructive Surgery ( doi: 10.1097/01.prs.0000475788.52446.7b ).


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