Postoperative Pain-control in Hand Surgery: A Single Institution Review of Opioid Prescription Practices by Orthopaedic Versus Plastic Surgeons

Abstract

PURPOSE: There is little consensus regarding postoperative pain management among hand surgeons. This study compares opioid prescription practices following hand surgery by orthopedic versus plastic surgeons. METHODS: We performed a retrospective analysis of all hand surgeries at a level-1-academic medical center from January 2016 to September 2018. Operations were classified by the specialty of the surgeon. The average morphine milligram equivalent (MME) prescribed on discharge following each surgery was calculated. Multivariate linear regression was performed controlling for patient age, race, gender, insurance type, and history of substance use or chronic pain. RESULTS: Five thousand one hundred forty-nine surgeries were identified (2,888 in orthopedics and 2,261 in plastic surgery). Orthopedic surgeons treated a higher proportion of women (58.5% versus 54.9%; P = 0.01) and caucasians (74.1% versus 66.6%; P < 0.0001), and fewer patients with history of substance abuse (9.9% versus 13.7%; P < 0.0001) than plastic surgeons. The mean MME prescribed across surgeries was 61.4. After adjusting for patient demographics and type of operation, plastic surgeons prescribed 15.9 more MME (P < 0.0001) per patient than orthopaedic surgeons. For common elective and nontrauma-based operations plastic surgeons prescribed 15.2 MME more than orthopaedic surgeons for carpal tunnel release (P < 0.0001; n = 1,967) and 41.1 MME for trigger finger release (P < 0.0001; n = 787). There was no statistically significant difference for operations related to traumatic mechanism (fractures, tendon lacerations, and nerve injuries). CONCLUSIONS: Our findings suggest inconsistency in prescribing practices among providers in plastic and orthopaedic surgery, highlighting the need for best practice guidelines relating to postoperative pain management in hand surgery.