Runge William, Gabig Andrew M, Karzon Anthony, Suh Nina, Wagner Eric R, Gottschalk Michael B
Investigation performed at the Emory Clinic, Atlanta, GA.
J Hand Surg Glob Online. 2023 Mar 31;5(3):338-343. doi: 10.1016/j.jhsg.2023.03.003. eCollection 2023 May.
Opioid pain medication is most commonly prescribed after distal radius fracture fixation, and there is high variability in the quantity and duration prescribed. Comorbidities, including substance use and depression, have been associated with higher consumption habits, and increased sizes of postoperative opioid prescriptions have been previously linked to an increasing risk of chronic opioid use and opioid use disorder. The purpose of this study was to investigate opioid prescription patterns after distal radius fracture fixation and identify patient-specific risk factors associated with increased opioid prescription refills.
A retrospective review of 34,629 opioid-naïve patients was conducted using the IBM MarketScan database. The database was queried to identify patient records from January 2009 to December 2017. Demographic, comorbidity, complication data, and prescription pharmacy claims were analyzed. Patients were sorted according to the duration of postoperative prescription refills of opioid pain medication.
Seventy-three percent of the patients required no additional refills outside the perioperative window. Twenty percent required additional refill prescriptions, and 6.4% of patients continued to fill the opioid medication beyond 6 months after surgery. Multiple factors increased the risk of increased opioid use, including medical and surgical complications, substance use, diabetes, cardiovascular disease, and obesity. Patients with a longer duration of opioid use after surgery had higher rates of medical and surgical complications. Perioperative prescription quantities were 62.9, 78.6, and 83.3 tablets for no refill, refill (<6M), and prolonged-use groups (>6M), respectively.
Patients who underwent distal radius fracture fixation were at greater odds for prolonged opioid use after surgery in the presence of comorbid cardiovascular, renal, metabolic, and mental health illnesses and postoperative medical and surgical complications. A greater understanding of patient-specific factors for prolonged opioid consumption after distal radius fracture fixation can help providers identify at-risk patients who would benefit from a tailored approach to counseling and multimodal pain management. Patients should be educated on these risks associated with their surgery and be provided with alternative medical options and health care resources to optimize pain control and reduce their need for opioid medication as their primary tool for pain relief.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
阿片类止痛药物是桡骨远端骨折固定术后最常用的处方药，其处方量和用药时长存在很大差异。包括物质使用和抑郁症在内的合并症与更高的用药习惯有关，术后阿片类药物处方量增加此前已被证明与慢性阿片类药物使用及阿片类药物使用障碍风险增加有关。本研究的目的是调查桡骨远端骨折固定术后的阿片类药物处方模式，并确定与阿片类药物处方续方增加相关的患者特异性风险因素。
使用IBM MarketScan数据库对34629例未使用过阿片类药物的患者进行回顾性研究。查询该数据库以识别2009年1月至2017年12月期间的患者记录。分析人口统计学、合并症、并发症数据以及处方药房索赔信息。根据阿片类止痛药物术后处方续方时长对患者进行分类。
73%的患者在围手术期窗口之外无需额外续方。20%的患者需要额外的续方处方，6.4%的患者在术后6个月后仍继续服用阿片类药物。多种因素会增加阿片类药物使用增加的风险，包括医疗和手术并发症、物质使用、糖尿病、心血管疾病和肥胖。术后阿片类药物使用时间较长的患者发生医疗和手术并发症的几率更高。无续方、续方（<6个月）和长期使用组（>6个月）的围手术期处方量分别为62.9、78.6和83.3片。
在存在心血管、肾脏、代谢和心理健康合并症以及术后医疗和手术并发症的情况下，接受桡骨远端骨折固定术的患者术后长期使用阿片类药物的几率更高。更好地了解桡骨远端骨折固定术后长期使用阿片类药物的患者特异性因素，有助于医疗服务提供者识别有风险的患者，这些患者将从量身定制的咨询方法和多模式疼痛管理中受益。应告知患者与其手术相关的这些风险，并为其提供替代医疗选择和医疗资源，以优化疼痛控制并减少其对阿片类药物作为主要止痛工具的需求。
研究类型/证据水平：治疗性III级。
