Notable Variability in Opioid-prescribing Practices After Common Orthopaedic Procedures
Authors: Daniel L Brinton
Michael B Gottschalk
Shane K Woolf
Lee R Leddy
Harris S Slone
Sophia A Traven
Journal: Journal of the American Academy of Orthopaedic Surgeons (2020)
Discipline: CLINICAL MEDICINE
Keywords: opioid prescriptions; orthopaedic procedures; regional variability; MarketScan database; post-op prescriptions
Affiliations: From the Department of Orthopaedics and Physical Medicine, the Medical University of South Carolina, Charleston, SC (Dr. Traven, Dr. Brinton, Dr. Woolf, Dr. Leddy, Dr. Slone), and the Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA (Dr. Gottschalk).

Abstract:  Introduction: The purpose of this study was to evaluate nationwide trends and regional variability in opioid prescriptions after common orthopaedic procedures. Methods: A retrospective analysis of privately insured subjects from the MarketScan database between 2015 and 2016 was conducted. Median oral morphine equivalents and interquartile ranges were analyzed by region for the initial post-op prescriptions and 90-day total prescriptions for opioid-naive patients undergoing the following: carpal tunnel release; anterior cruciate ligament reconstruction; arthroscopic meniscectomy; bimalleolar ankle fracture open reduction and internal fixation; distal radius fracture open reduction and internal fixation; arthroscopic rotator cuff repair; single-level anterior cervical discectomy and fusion; and total shoulder, hip, and knee arthroplasties. We hypothesized that notable regional variability exists with postoperative narcotic prescribing habits. Results: Seventy three thousand nine hundred twenty-one opioid-naive patients were identified. A notable regional variability was observed across the United States in the prescriptions given for all procedures, except total joint arthroplasty. Furthermore, although patients undergoing soft-tissue-only procedures required the fewest refills, patients undergoing total joint arthroplasty required the most. Discussion: Notable regional variability exisits in opioid prescribing patterns for many common orthopaedic procedures. Furthermore, prescriptions were smallest in the region most affected by the opioid epidemic. This information can be used to re-evaluate recommendations, serve as a benchmark for surgeons, and develop institutional and quality improvement guidelines to reduce excess postoperative opioid prescriptions. Level of evidence: Level III observational cohort study. 

Retracted: No

PubPeer comments:
 This is a timely and important topic. Some suggestions that the authors should consider for future manuscripts: 1) The first column of the first page of this clinical report notes  This is a non-human subjectsu2019 study. 2) The second sentence of the introduction includes:  Americans consume 80% of the worldu2019s global opioid supply while representing only 5% of the worldu2019s cohort. The citation refers to an empirical paper (Kim et al. J Bone Joint Surg Am 2016) which doesn t address this directly. Their discussion does cite another decade only review (Manchikanti L, Singh A. Therapeutic opioids: a ten-year perspective on the complexities and complications of the escalating use, abuse, and nonmedical use of opioids. Pain Physician. 2008 Mar;11(2)(Suppl):S63-88. This  80% is discussed in various places online including: https: www.politifact.com factchecks 2017 may 10 claire-mccaskill mccaskill-cites-long-disproven-figure-opioid-use 3) Table 3 could be more impactful if it included statistics, even chi-squares. ,