The Effect of Preoperative Counseling on Duration of Postoperative Opiate Use in Orthopaedic Trauma Surgery: A Surgeon-Based Comparative Cohort Study.
Holman, Joel E. MD *; Stoddard, Gregory J. MPH *; Horwitz, Daniel S. MD +; Higgins, Thomas F. MD *
Journal of Orthopaedic Trauma.
28(9):502-506, September 2014.
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Objective: The prudent use of prescription opiates is a central aspect of current postsurgical pain management, but surgeons have no guidelines on appropriate duration of opiate treatment. Furthermore, there are no established data on the effect of physician counseling on the duration of opiate use postoperatively.
Design: Retrospective surgeon-controlled cohort study.
Setting: Level I regional academic trauma center.
Patients: All Utah residents admitted to the orthopaedic trauma service with isolated operative musculoskeletal injury.
Intervention: One group of patients was instructed at the time of index procedure that they would receive prescription opiates for a maximum of 6 weeks. The remaining patients were not counseled preoperatively on duration of opiate use postoperatively.
Main Outcome Measures: The presence and frequency of prescription opiate use before injury, cessation of opiate use by 6 weeks postoperatively, cessation of opiates by 12 weeks postoperatively, and continuation of prescription opiates greater than 12 weeks postoperatively.
Results: Six hundred thirteen patients met inclusion criteria. Those counseled preoperatively to cease opiate use by 6 weeks were significantly more likely to do so than those who did not receive counseling (73% and 64%, respectively; P = 0.012). By 12 weeks, this effect was no longer seen, and patients were just as likely to have stopped (80% and 80%, respectively; P = 0.90).
Conclusions: The orthopaedic trauma population is significantly more likely than the general population to be using prescription opiates before injury. Physician discussion of 6-week opiate prescription limitation at the time of injury seems to lead to a lower rate of use at the 6-week postoperative mark but has no effect on rates of longer-term use. Twenty percent of patients in either group will continue to use opiates after 12 weeks, compared with 15% before injury. Given the scope of prescription opiate use in the United States, surgeons may want to consider preoperative discussion of this issue, but it may not have any effect on usage rates at longer intervals.
Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
(C) 2014 by Lippincott Williams & Wilkins