Thurs., 10/8/09 Pediatrics & Injury Prevention, Paper #30, 3:15 pm OTA-2009
Prescription Narcotic Use before and after Orthopedic Trauma Surgery and the Effect of Perioperative Counseling
Joel Holman, MD (n); Thomas F. Higgins, MD (4-Smith &Nephew);
Daniel S. Horwitz, MD (5-DePuy);
University of Utah, Department of Orthopedics, Salt Lake City, Utah, USA
Purpose: The use and potential abuse of prescription narcotics has become widespread in the United States. The purpose of this study is to establish the baseline rate for prescription narcotic use in orthopaedic trauma patients for the 3 months prior to their trauma, and to determine the percentage using prescription narcotics greater than 12 weeks after their injury. Further, this study aims to determine if perioperative physician narcotic counseling affects the duration of postoperative narcotic use. The hypothesis is that discussion of narcotic expectations perioperatively will limit duration of postoperative use.
Methods: Using the Utah Controlled Substance Data Base (UCSD), narcotic prescriptions were recorded for patients treated surgically at the University of Utah Level 1 regional trauma center between July 2005 and June 2007. Patients were excluded if (1) they were flown from surrounding states, and therefore not in the UCSD; (2) there was no record of postoperative narcotic use in the UCSD; (3) they sustained multisystem trauma; and/or (4) they required further surgery for nonunion, malunion, or complication. Counseling was determined by surgeon randomization. Trauma surgeon 1 (TS1) informed all of his patients at the time of injury that they would receive narcotics for a maximum of 6 weeks postoperatively. Trauma surgeon 2 (TS2) did not discuss narcotics perioperatively and limited postoperative narcotic use to 12 weeks.
Results: 1,109 patients were treated over the 2-year period. After exclusion, 615 patients were available for analysis. 15% of all orthopaedic trauma patients had obtained narcotics within 3 months prior to injury and 12% had obtained more than 1 prescription. TS1 treated 292 patients and 215 (74%) were narcotic-free at 6 weeks. TS2 treated 323 patients and 206 (64%) were narcotic-free at 6 weeks. This difference was significant (P = 0.0092, 2-tailed Fisher exact test). There was no significance between treating surgeons at 12 weeks (81% and 80%, respectively). Of those patients obtaining more than 1 prescription preinjury, 72% continued to take narcotics beyond 12 weeks. One-third (33%) of all patients obtained a narcotic prescription from someone besides the treating surgeon during a 6-month postoperative interval. Patients on the 6-week limit and patients on the 12-week limit were equally likely to obtain narcotics from a source other than their surgeon after they reached their limit (32% vs 35%).
Conclusion: 15% of orthopaedic trauma patients are taking prescription narcotics prior to their injury. Perioperative counseling can decrease the duration of postoperative narcotic use in orthopaedic trauma patients in the short term, but does not appear to have an effect at 3 months. One-third of patients will obtain a narcotic prescription from someone other than their surgeon. This information demonstrates some of the limits of preoperative counseling, but may help to guide treating surgeons in shaping their postoperative narcotic treatment regimen.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant