Opioid Prescription Following Wrist and Ankle Fracture Fixation in Scotland-Tradition Prevails.

William T Gardner,Stuart A Aitken,Iain M Stevenson,Alastair C Faulkner,Matthew J Kennedy,Patrice Forget,David R W Macdonald,Joshua R Mcintyre

doi:10.3390/jcm11020468

Abstract

The American ‘opioid crisis’ is rapidly spreading internationally. Perioperative opioid use increases the risk of long-term opioid use. We review opioid use following wrist and ankle fracture fixation across Scotland, establishing prescribing patterns and associations with patient, injury, or perioperative factors. Six Scottish orthopedic units contributed. A total of 598 patients were included. Patient demographics were similar across all sites. There was variation in anesthetic practice, length of stay, and AO fracture type (p < 0.01). For wrist fractures, 85.6% of patients received a discharge opioid prescription; 5.0% contained a strong opioid. There was no significant variation across the six units in prescribing practice. For ankle fractures, 82.7% of patients received a discharge opioid prescription; 17% contained a strong opioid. Dundee and Edinburgh used more strong opioids; Inverness and Paisley gave the least opioids overall (p < 0.01). Younger patient age, location, and length of stay were independent predictors of increased prescription on binary regression. Despite variability in perioperative practices, discharge opioid analgesic prescription remains overwhelmingly consistent. We believe that the biggest influence lies with the prescriber-institutional ‘standard practice’. Education of these prescribing clinicians regarding the risk profile of opioids is key to reducing their use following surgery, thus lowering long-term opioid dependence.

Highlights

A total of 598 patients were included in this retrospective cohort study, all of whom had received surgical management of an isolated acute distal radius (298) or ankle (300) fracture
Gender, rates of depression/anxiety, and pre-injury opioid use were similar across the six sites
When considering the ankle fracture cohort, patient demographics and injury selection for surgical intervention are generally consistent across Scotland, but anesthetic and surgical practices do show some variation, along with length of stay post-operatively

Summary

Introduction

The USA and Canada have struggled with an ‘opioid crisis’ over the last few decades and have had to implement rigorous measures to monitor and regulate their prescription [1]. This issue is not unique to the North American continent; rates of opioid use and abuse are rising within the UK [2], with the issuing of prescriptions not always in line with best practice guidance [3,4]. It has been suggested that the rationale behind opioid prescribing is often more to do with accepted practices and prescriber-dependent behavior than any true clinical reason [9,10]

Methods

Results

Discussion

Conclusion