Department of Orthopedic Surgery, Wayne State University, Detroit, MI; and.
Department of Orthopaedics, Detroit Medical Center, Detroit, MI.
J Orthop Trauma. 2024 Nov 1;38(11):e355-e361. doi: 10.1097/BOT.0000000000002891.
To assess patients' opioid prescription usage and pain management satisfaction after fracture surgery.
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.
Single-Center Level One Trauma Center.
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 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.
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%).
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.
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
评估骨折手术后患者的阿片类药物处方使用情况和疼痛管理满意度。
对接受骨折手术后的患者进行了一项经过机构审查委员会批准的前瞻性预后队列研究。在术后 2 周、6 周、3 个月和 6 个月，由一名独立观察者对患者进行评估，他们接受了关于术后疼痛和阿片类药物使用情况的底特律介入性疼痛评估问卷。通过密歇根州自动处方系统验证阿片类药物处方。所有患者均分为主要骨折（胫骨、股骨、髋臼、骨盆、跟骨、距骨、多发性创伤）和次要骨折（肩胛骨、锁骨、肱骨、桡骨、尺骨、舟骨、腕骨/掌骨、髌骨、腓骨、踝关节、跖骨），并随访 2 年。
单中心一级创伤中心。
在 6 个月期间到诊所就诊的患者被邀请参加这项研究。不同意的患者被排除在外。
结局测量包括每天吗啡毫克当量（MME）的规定阿片类药物用量、阿片类药物使用情况、DIPA 疼痛评分和疼痛管理效率（报告无疼痛或可耐受疼痛的患者比例）。比较了所有术后期间的规定 MME、疼痛管理效率评分和使用阿片类药物的患者比例。
在 201 名骨折患者中，平均年龄为 47.8 ± 16.3 SD（18-87 岁），其中 116 名男性（57.8%）和 85 名女性（42.2%）。从术后 2 周（48.2%，21.6 MME）到 6 个月（10.3%，8.13 MME），使用阿片类药物的患者比例及其每日规定的 MME 显著下降（P<0.001）。51%的患者在术后 2 周停用阿片类药物，64.5%在术后 6 周，84.2%在术后 3 个月，89.7%在术后 6 个月。所有在术后 6 个月和 2 年的阿片类药物处方均开给经历序贯手术的多发性创伤患者，这些处方来自外部开方者。疼痛管理效率评分在术后 2 周时最差（67.2%），但在术后 3 个月时有所改善（82.6%）。
随着患者与手术日期的进一步推移，阿片类药物处方和患者报告的阿片类药物使用量减少。尽管外科医生采取了阿片类药物逐渐减少的措施，但多发性创伤患者在术后 3 个月后仍收到来自外部开方者的骨科后续治疗处方，表明在此之后患者需要看外部开方者来进行疼痛管理。
预后 III 级。有关证据水平的完整描述，请参见作者指南。
