Implementing Prescribing Guidelines for Upper Extremity Orthopedic Procedures: A Prospective Analysis of Postoperative Opioid Consumption and Satisfaction

Abstract

Background: A lack of established opioid-prescribing guidelines has prompted recent studies to propose preliminary guidelines to mitigate inadvertent overprescribing, diversion, and abuse. The purpose of our study was to assess the efficacy of a specific set of opioid-prescribing guidelines by prospective evaluation of patient consumption and satisfaction. Methods: During a consecutive period, all patients undergoing outpatient upper extremity surgical procedures were postoperatively prescribed opioids based on published guidelines that were specific to the anatomical location and procedure being performed. At the first postoperative visit, surgical details, opioid consumption patterns, and prescription efficacy and satisfaction were recorded. Results: A total of 201 patients reported any amount of prescription use, resulting in a mean consumption of 5.5 pills. Patients who underwent soft tissue procedures reported the lowest requirement (4.2 pills) compared with those who underwent fracture repairs (6.7 pills) or arthroscopy and arthroplasty/fusion procedures (8.7 pills). Patients undergoing hand procedures consumed fewer opioids (3.9 pills) compared with those undergoing wrist (6.3 pills) or elbow (8.1 pills) procedures. Of the patients requiring opioids, 82% reported being satisfied or at least neutral to the prescribed quantity (P < .001), and 92% reported being satisfied or at least neutral to the prescribed opioid analgesic efficacy (P < .001). Overall, the study refill request rate was 13%. Conclusions: Although the proposed guidelines tended to exceed patient need, the study confirmed strong patient satisfaction and an overall refill request rate of only 13%. We conclude that following anatomical and procedure-specific opioid-prescribing guidelines is an effective method of prescribing opioids postoperatively after upper extremity.

Keywords: anatomy; forearm; guidelines; hand; opioid; pain management; patient satisfaction; prescribing; specialty.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.

The percentage of prescription use by (a) procedure type, (b) anatomical location, and (c) anesthesia type. Patients who used any amount of prescription are represented in blue, and those who did not use the prescription are represented in orange.

Figure 2.

The mean number of pills by (a) sex, (b) procedure type, (c) anatomical location, and (d) anesthesia type. The error bars indicate the standard deviation.

Figure 3.

The percentage of refills by (a) procedure type, (b) anatomical location, and (c) anesthesia type. Patients who requested any prescription refill amount are represented in blue, and those who did not request any prescription refills are represented in orange.