The effect of surgical pain severity, preoperative opioid use and patient characteristics on postoperative opioid prescriptions and refills in orthopedic surgery.

Abstract

Excessive opioid prescriptions after orthopedic surgery are common. The purpose of this study was to examine the association between surgical severity, preoperative opioid use and patient characteristics with postoperative opioid prescriptions and refills. Seventy-nine patients undergoing orthopedic surgeries were reviewed. Surgical pain severity was categorized as mild (n = 25), moderate (n = 26) and severe (n = 28). Patients were also categorized as opioid naïve (n = 57), experienced (n = 16) and tolerant (n = 6). Postoperative and refill prescriptions were reviewed to determine morphine equivalent dose (MED) prescribed. Mild, moderate and severe pain surgeries received a median (interquartile range) equivalent of 20 (0, 30), 53 (33, 80) and 60 (45, 80) oxycodone 5mg tablets, respectively. Excessive opioid prescriptions (> 400 MED) were given to 37 (46%) patients. There was no difference in the total discharge MED between moderate and severe pain surgeries or between opioid naïve and opioid-experienced patients (p > 0.05). Variables associated with excessive postoperative opioid prescriptions on multivariate analysis-included severe pain surgery (odds ratio 7.7, 95% confidence interval 2 to 25; p < 0.01) and anesthetic block (odds ratio 4.5, 95% confidence interval 1.4 to 14; p < 0.01). Variables associated with opioid refill on multivariate analysis included an American Society of Anesthiologists Physical Status (ASA) score > I (odds ratio 11, 95% confidence interval: 1.3 to 92; p < 0.01) and preoperative pain VAS (odds ratio 1.2, 95% confidence interval 1.01 to 1.4; p = 0.02). The adoption of opioid prescription guidelines is warranted to differentiate between surgical severities and decrease the range and size of postoperative opioid prescriptions.