A prescribing protocol decreases the rate of chronic opioid use in orthopaedic trauma patients: a prospective quality improvement study

Abstract

Background: There is a clear need for orthopaedic-specific protocols to minimize the risks of prolonged opioid use after surgery. The authors assessed the effect of an opioid-prescribing protocol on new persistent opioid use in patients who were treated surgically for fractures. The hypothesis of this study was that the protocol would reduce the rate of new persistent opioid use. Methods: The study cohort consisted of patients who were treated at a level 1 trauma center before and after implementation of an opioid prescribing protocol. One hundred twenty-two patients prior to protocol implementation and 103 patients after protocol implementation met inclusion criteria. The primary outcome measured was persistent opioid use more than 6 mo postoperatively. Results: There was a significant decrease in the rate of new persistent opioid use in the protocol group from 25% to 12%. The number of patients who needed to be treated to prevent one case of new persistent opioid use was eight. Age was a significant risk factor for new persistent opioid use. For each additional year in age, risk increased by 3%. Conclusions: The authors studied the effect of implementing a protocol for prescribing opioids at a Level 1 trauma center and found a statistically and clinically significant decrease in the rate of new persistent opioid use after implementation of the protocol. Increasing age was identified as an independent risk factor for new persistent opioid use. Level of Evidence: Level III.