Evaluating Postoperative Pain Management Using the Detroit Interventional Pain Management Tool After Fracture Surgery: How Well Are We Really Doing?

OBJECTIVES

To assess patients' opioid prescription usage and pain management satisfaction after fracture surgery.

DESIGN

An IRB-approved prospective prognostic cohort study for postoperative patients with fracture was conducted. Patients were evaluated by an independent observer at 2 weeks, 6 weeks, 3 months, and 6 months postoperatively where they were given Detroit Interventional Pain Assessment questionnaires regarding their postoperative pain and opioid usage. Opioid prescriptions were verified by the Michigan Automated Prescription System. All patients were divided into major fractures (tibia, femur, acetabulum, pelvis, calcaneus, talus, and polytrauma) and minor fractures (scapula, clavicle, humerus, radius, ulna, scaphoid, carpal/metacarpal, patella, fibula, ankle, and metatarsal) and were followed for 2 years.

SETTING

Single-Center Level One Trauma Center.

PATIENT SELECTION CRITERIA

Patients presenting to clinic over a 6-month period were invited to participate in this study. Patients who did not consent were excluded.

OUTCOME MEASURES AND COMPARISONS

Outcome measures were the amount of prescribed opioids in daily morphine milligram equivalents (MMEs), opioid usage, DIPA pain scores, and pain management efficiency (percentage of patients reporting no pain or tolerable pain with their regimen). Prescribed MMEs, pain management efficiency scores, and the percentage of patients using opioids were compared across all postoperative periods.

RESULTS

For 201 patients with fracture, the average age was 47.8 ± 16.3 SD (18-87 years), and there were 116 men (57.8%) and 85 women (42.2%). The percentage of patients using opioids and their daily prescribed MMEs significantly decreased from 2 weeks (48.2%, 21.6 MMEs) to 6 months (10.3%, 8.13 MMEs) ( P < 0.001). Fifty-one percent of patients were off opioids at 2 weeks, 64.5% at 6 weeks, 84.2% at 3 months, and 89.7% at 6 months. All opioid prescriptions at 6 months and 2 years were prescribed to patients with polytrauma who underwent sequential surgeries, and these prescriptions originated from outside prescribers. Pain management efficiency scores were worst at 2 weeks (67.2%) but improved at 3 months (82.6%).

CONCLUSIONS

As patients transitioned further from their surgical date, there was a decrease in opioid prescriptions and patient-reported opioid usage. Despite the opioid tapering practices by surgeons, patients with polytrauma still received prescriptions from outside prescribers for orthopaedic aftercare after 3 months, signaling the necessity for patients to see outside prescribers for their pain management after this time.

LEVEL OF EVIDENCE

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.