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