standardization of post-operative opiate prescriptions for same-day ankle and wrist fracture surgeries

Conditions: Opioid Use; Post-operative Pain; Prescription Opioid Abuse; Fracture, Ankle; Fracture Wrist; Surgery

Summary: the purpose of this prospective cohort study is to evaluate the opiate prescribing patterns post open reduction and internal fixation (orif) of wrist and ankle fractures at the ottawa hospital. the primary objective would be to examine the quantity and duration of opiates consumed by the study population, as well as the participant's overall satisfaction with pain control. the investigators will assess whether there is a discrepancy between the quantity of pills prescribed and what is being consumed. with the data collected, the secondary objective would be to create a standardized pain prescription, which the investigators would implement in the second phase of this prospective study. opiate pills consumed, pain satisfaction and left-over narcotics would again be assessed. the overall goal of this study is to produce an appropriate standardized post-operative prescription, where the number of opiates prescribed mirrors what is being consumed. this would cut down on the quantity of left-over narcotics, helping to reduce the incidence of opiate dependency and diversion in the ottawa community.

this is a multiphase study that will begin with a retrospective review of the prescribing patterns at the ottawa hospital. the post-operative prescriptions of 50 wrist fracture and 50 ankle fracture patients booked for same day fracture fixation will be reviewed. the type and quantity of opiate pills prescribed, as well as the other multimodal analgesics prescribed will be collected. phase one will provide the investigators with data regarding the recent prescribing trends at the ottawa hospital prior to beginning the prospective phase of the study. phase two and three of the study involves collecting data from two prospectively collected cohorts - the standard of care cohort (phase 2) and the standardized prescription cohort (phase 3). in phase two, eligible wrist and ankle fracture patients booked for open reduction and internal fixation through the walking wounded (emergency day surgery) program will be recruited and consented via telephone prior to their surgery date. the study participants will receive a post-operative prescription at the discretion of their attending surgeon, fellow or resident, with no intervention from the researchers involved in this study. on post-operative day three and post-operative day ten, these patients will be contacted by phone by the research team and asked to respond verbally to a questionnaire that will record the following measures - quantity of opiates consumed/left-over, pain intensity, satisfaction with pain treatment and other non-opiate medications taken. using the data collected from phase two, a standardized pain prescription will be created. the average quantity of opiates consumed by the phase two participants will be used to guide the quantity of opiates to be prescribed on the standardized prescription. similar to recruitment in phase two, in phase three, all eligible patients will be contacted and recruited by telephone prior to their surgery. these patients will be flagged on the day of surgery and given the standardized prescription post-operatively. they will then be asked to respond to the same questionnaires via telephone on post-op day three and post-op day ten.

Eligibility criteria:
inclusion criteria: * ankle and wrist fracture patients booked for orif (via walking wounded program) * opioid naïve (opiates prescribed in emergency not included) * competent to give informed consent and respond to questionnaires independently * english or french speaking exclusion criteria: * admission to hospital pre- or post-operatively * chronic opioid use for pain unrelated to injury * chronic pain in injured extremity, unrelated to acute injury * previous fracture/surgery to injured limb * revision orif * dementia or cognitive impairment