Opioid Use Among Orthopaedic Patients and Comparison of Opioid Prescribing Patterns Among Spine Surgeons and Other Orthopaedic Subspecialists in the United States

Main Article Content

Chadi Tannoury, MD Rahul Bhale, MD Justin Koh, MD Aziz Saade, MD Christopher Maatouk, MD Tony Tannoury, MD

Abstract

Background/Introduction: The US opioid epidemic has received particular attention with 33091 reported deaths from narcotic overdose in 2015. A recent survey comparing US and Japanese opioid prescribing patterns from the AOA-JOA traveling fellows included 76 US orthopedic surgeons representing 8 subspecialties. We used this data to compare opioid prescribing patterns among US spine surgeons to other orthopaedic subspecialties.


Materials/Methods: The survey included data based on surgeon demographics (gender, age, years in practice), patient baseline opioid use (pre/post-operative opioid use, types of opioid agents, duration of opioid use), perioperative pain management (procedure/institution factors, multimodal analgesic therapy), and responses to questions regarding opioid use attitudes. Survey responses were recorded as either categorical or semi-continuous variables. Statistical analysis was performed using chi-squared analysis for categorical responses and Kolmogorov-Smirnov testing to a statistical significance level of p < 0.05. Parameters that trended toward significance to p < 0.10 were also recorded. Statistical analysis was performed using Stata statistical analysis software [StataCorp, College Station, Texas].


Results: Spine patients were more likely using opioid medications prior to evaluation by spine surgeons compared to non-spine patients(p=0.029). Patients with spine pathologies treated non-operatively were also more likely to be prescribed opioids(p=0.006). Post-operatively, spine patients were less likely to stop opioid prescriptions on the intended time (p=0.046). Peri-operatively, spine patients were more likely to be given muscle relaxant medications, and less likely to receive local/regional anesthesia(p=0.0025). Additionally, spine patients showed a trend toward association for requesting additional opioids beyond their initial prescription(p=0.057). Spine surgeons showed a trend toward association for choice of opioid agent prescribed–spine patients were less likely to receive codeine/tramadol analogs(p=0.062). When surveyed on opinions regarding opioid use, US spine surgeons did not show significantly different opinions regarding opioid use compared to surgeons in other subspecialties.


Discussion/Conclusion: Spine patients did demonstrate statistically significant patterns of opioid use, particularly regarding opioid use prior to evaluation by orthopedic surgeon and use of opioids for nonoperative pathologies. They were also less likely to stop opioid prescriptions on time. Surgeon prescription patterns and perceptions of opioid use were not significantly different for spine surgeons compared to other subspecialties.

Article Details

How to Cite
TANNOURY, Chadi et al. Opioid Use Among Orthopaedic Patients and Comparison of Opioid Prescribing Patterns Among Spine Surgeons and Other Orthopaedic Subspecialists in the United States. Medical Research Archives, [S.l.], v. 10, n. 8, aug. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2984>. Date accessed: 07 oct. 2022. doi: https://doi.org/10.18103/mra.v10i8.2984.
Section
Research Articles

References

1. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep. 2016;65(5051):1445-1452. doi:10.15585/mmwr.mm655051e1
2. Sabatino MJ, Kunkel ST, Ramkumar DB, Keeney BJ, Jevsevar DS. Excess Opioid Medication and Variation in Prescribing Patterns Following Common Orthopaedic Procedures. J Bone Joint Surg Am. 2018;100(3):180-188. doi:10.2106/JBJS.17.00672
3. Thiels CA, Anderson SS, Ubl DS, et al. Wide Variation and Overprescription of Opioids After Elective Surgery. Ann Surg. 2017;266(4):564-573. doi:10.1097/SLA.0000000000002365
4. Chen EY, Marcantonio A, Tornetta P. Correlation Between 24-Hour Predischarge Opioid Use and Amount of Opioids Prescribed at Hospital Discharge. JAMA Surg. 2018;153(2):e174859. doi:10.1001/jamasurg.2017.4859
5. Schnitzer TJ, Gray WL, Paster RZ, Kamin M. Efficacy of tramadol in treatment of chronic low back pain. J Rheumatol. 2000;27(3):772-778.
6. Mahowald ML, Singh JA, Majeski P. Opioid use by patients in an orthopedics spine clinic. Arthritis Rheum. 2005;52(1):312-321. doi:10.1002/art.20784
7. Schoenfeld AJ, Nwosu K, Jiang W, et al. Risk Factors for Prolonged Opioid Use Following Spine Surgery, and the Association with Surgical Intensity, Among Opioid-Naive Patients. J Bone Joint Surg Am. 2017;99(15):1247-1252. doi:10.2106/JBJS.16.01075
8. Walid MS, Hyer L, Ajjan M, Barth ACM, Robinson JS. Prevalence of opioid dependence in spine surgery patients and correlation with length of stay. J Opioid Manag. 2007;3(3):127-128, 130-132.
9. Armaghani SJ, Lee DS, Bible JE, et al. Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery. Spine. 2014;39(25):E1524-1530. doi:10.1097/BRS.0000000000000622
10. Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SRB. Characteristics of opioid prescriptions in 2009. JAMA. 2011;305(13):1299-1301. doi:10.1001/jama.2011.401
11. Nota SPFT, Spit SA, Voskuyl T, Bot AGJ, Hageman MGJS, Ring D. Opioid Use, Satisfaction, and Pain Intensity After Orthopedic Surgery. Psychosomatics. 2015;56(5):479-485. doi:10.1016/j.psym.2014.09.003
12. Miller LE, Kamath AF, Boettner F, Bhattacharyya SK. In-hospital outcomes with anterior versus posterior approaches in total hip arthroplasty: meta-analysis of randomized controlled trials. J Pain Res. 2018;11:1327-1334. doi:10.2147/JPR.S166058
13. Westermann RW, Pugely AJ, Martin CT, Gao Y, Wolf BR, Hettrich CM. Reverse Shoulder Arthroplasty in the United States: A Comparison of National Volume, Patient Demographics, Complications, and Surgical Indications. Iowa Orthop J. 2015;35:1-7.
14. Roche M, Law TY, Sodhi N, et al. Incidence of Drug Abuse in Revision Total Knee Arthroplasty Population. J Knee Surg. September 2018. doi:10.1055/s-0038-1669915
15. Berglund DD, Rosas S, Kurowicki J, Mijic D, Levy JC. Effect of opioid dependence or abuse on opioid utilization after shoulder arthroplasty. World J Orthop. 2018;9(8):105-111. doi:10.5312/wjo.v9.i8.105
16. Saini S, McDonald EL, Shakked R, et al. Prospective Evaluation of Utilization Patterns and Prescribing Guidelines of Opioid Consumption Following Orthopedic Foot and Ankle Surgery. Foot Ankle Int. August 2018:1071100718790243. doi:10.1177/1071100718790243
17. Bargon CA, Zale EL, Magidson J, Chen N, Ring D, Vranceanu A-M. Factors Associated With Patients’ Perceived Importance of Opioid Prescribing Policies in an Orthopedic Hand Surgery Practice. J Hand Surg. August 2018. doi:10.1016/j.jhsa.2018.06.118
18. Azad T, Vail D, Bentley J, et al. Initial Provider Specialty is Associated with Long-term Opiate Use in Patients with Newly Diagnosed Low Back and Lower Extremity Pain. Spine. August 2018. doi:10.1097/BRS.0000000000002840
19. Jain N, Brock JL, Phillips FM, Weaver T, Khan SN. Chronic preoperative opioid use is a risk factor for increased complications, resource use, and costs after cervical fusion. Spine J Off J North Am Spine Soc. April 2018. doi:10.1016/j.spinee.2018.03.015
20. Tank A, Hobbs J, Ramos E, Rubin DS. Opioid Dependence and Prolonged Length of Stay in Lumbar Fusion: A Retrospective Study Utilizing the National Inpatient Sample 2003-2014. Spine. May 2018. doi:10.1097/BRS.0000000000002714
21. Lee D, Armaghani S, Archer KR, et al. Preoperative Opioid Use as a Predictor of Adverse Postoperative Self-Reported Outcomes in Patients Undergoing Spine Surgery. J Bone Joint Surg Am. 2014;96(11):e89. doi:10.2106/JBJS.M.00865
22. Kidner CL, Mayer TG, Gatchel RJ. Higher opioid doses predict poorer functional outcome in patients with chronic disabling occupational musculoskeletal disorders. J Bone Joint Surg Am. 2009;91(4):919-927. doi:10.2106/JBJS.H.00286
23. Morris BJ, Laughlin MS, Elkousy HA, Gartsman GM, Edwards TB. Preoperative opioid use and outcomes after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2015;24(1):11-16. doi:10.1016/j.jse.2014.05.002
24. Zywiel MG, Stroh DA, Lee SY, Bonutti PM, Mont MA. Chronic opioid use prior to total knee arthroplasty. J Bone Joint Surg Am. 2011;93(21):1988-1993. doi:10.2106/JBJS.J.01473
25. Helmerhorst GTT, Vranceanu A-M, Vrahas M, Smith M, Ring D. Risk factors for continued opioid use one to two months after surgery for musculoskeletal trauma. J Bone Joint Surg Am. 2014;96(6):495-499. doi:10.2106/JBJS.L.01406
26. American Medical Association Opioid Task Force. American Medical Association Opioid Task Force 2018 Progress Report. Chicago https://www.ama-assn.org/sites/default/files/media-browser/public/physicians/patient-care/opioid-task-force-progress-report.pdf. Accessed October 9, 2018.
27. Morris BJ, Mir HR. The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg. 2015;23(5):267-271. doi:10.5435/JAAOS-D-14-00163
28. Manchikanti L, Helm S 2nd, Fellows B, et al. Opioid epidemic in the United States. Pain Physician. 2012;15(3 Suppl):ES9-ES38.
29. Ladha KS, Neuman MD, Broms G, et al. Opioid Prescribing After Surgery in the United States, Canada, and Sweden. JAMA Netw Open. 2019;2(9):e1910734. Published 2019 Sep 4. doi:10.1001/jamanetworkopen.2019.10734
30. Young JD, Bhashyam AR, Qudsi RA, et al. Cross-Cultural Comparison of Postoperative Discharge Opioid Prescribing After Orthopaedic Trauma Surgery. J Bone Joint Surg Am. 2019;101(14):1286-1293. doi:10.2106/JBJS.18.01022
31. Tannoury C, Kleweno C, Kamath AF, Gary J. Comparison of opioid use and prescribing patterns in orthopedic surgery in Japan and the United States: A JOA-AOA Traveling Fellowship Investigation. J Orthop Sci. 2020;25(3):520-524. doi:10.1016/j.jos.2019.04.014