A retrospective cohort review of opioid prescribing and patient-reported consumption patterns following upper extremity surgery

Abstract

Background: Across upper extremity procedures, patients are being prescribed approximately three times the opioid medication needed. The aim of this study was to evaluate opioid prescribing and consumption trends for patients undergoing various upper extremity surgeries at a regional medical center to further refine prescribing guidelines. Methods: A retrospective review of 152 patients undergoing shoulder, wrist, and forearm or hand surgery who completed a patient-reported opioid consumption tracking form between June 2017 and May 2018 was conducted. Opioid prescription and consumption data were converted into morphine milligram equivalents (MMEs). Results: Average total MME prescribed for the population was 147.5±130.1 MME and was significantly different across procedures (P<0.001). Average MME taken across the cohort was 55.5±61.5 with significant differences across procedure types (P<0.001). Controlling for gender and patient age, when compared with shoulder patients, patients undergoing wrist and forearm or hand procedures were significantly less likely to be overprescribed (OR=0.309, P=0.014; OR=0.225, P=0.001) and were overprescribed less MME on average (wrist and forearm β=−120.1, P<0.001; hand β=−144.4, P<0.001). There was no significant difference in the percentage of patients requiring second opioid fills, with an average refill rate of 14.5% across the cohort (P=0.116). Conclusions: Significant differences in the need for opioid analgesia exist across upper extremity procedures, with shoulder surgery patients being overprescribed most frequently and by the highest MMEs. Due to the variability in narcotic utilization, patient-specific factors must be considered by providers when determining optimal opioid prescribing levels. Level of Evidence: Level IV.