Geographic variation in the frequency and potency of postoperative opioid prescriptions for extremity fracture surgery. A retrospective cohort study

W Timothy Gardner; Sophie E Pitts; Colin T Patterson; Jack Richards; David Neilly; Peter Smitham; Iain Stevenson; Stuart A Aitken

doi:10.1016/j.jcot.2022.101921

Geographic variation in the frequency and potency of postoperative opioid prescriptions for extremity fracture surgery. A retrospective cohort study

J Clin Orthop Trauma. 2022 Jun 16:30:101921. doi: 10.1016/j.jcot.2022.101921. eCollection 2022 Jul.

Authors

W Timothy Gardner¹, Sophie E Pitts¹, Colin T Patterson¹, Jack Richards², David Neilly^{1

2}, Peter Smitham², Iain Stevenson¹, Stuart A Aitken³

Affiliations

¹ Aberdeen Royal Infirmary, Aberdeen, Scotland, UK.
² Royal Adelaide Hospital, Adelaide, Australia.
³ MaineGeneral Orthopedics, Augusta, ME, USA.

Abstract

Introduction: There is increasing evidence that the prescription opioid crisis is spreading internationally. However, there is scarce literature comparing contemporary prescribing practices between units in different countries, particularly in the context of this evolving international problem. We sought to determine the patterns of postoperative opioid prescribing in three hospitals from geographically distinct regions.

Methods: This is a retrospective cohort study involving patients from three hospitals: XXX, Maine, USA; XXX, Scotland; and XXX, Australia. The health records, surgical details, and frequency and potency of discharge prescriptions were analyzed for 350 patients receiving surgery for isolated wrist or ankle fractures. Regression analysis was used to identify independent predictors of prescription opioid provision.

Results: Following ankle fracture surgery, Aberdeen patients (OR 6.0, 95% CI 3.0-11.5) and Adelaide patients (11.8, 95% CI 4.1-39.6) were significantly more likely to receive a prescription for opioids than those in Augusta (p < 0.001). For distal radius fractures, this was also the case (Aberdeen OR 21.2, 95% CI 7.2-79.3, Adelaide OR 21.6, 95% CI 7.3-81.3). For both fracture groups, the potency of prescription provided (measured in morphine milligram equivalents) was not significantly different. When opioids were included in the discharge prescription, Adelaide prescribers favored strong opioids, Aberdeen prescribers selected weak opioids, and prescribers in Augusta chose an even distribution of both types (p < 0.001). Multivariate analysis demonstrated that the odds of receiving prescription opioids were significantly influenced by geographic location and decreased by advancing patient age.

Conclusions: Geographic location is a key factor influencing the provision of postoperative opioids. We found no association with fracture type, patient demographic factors or intra-operative practices. Prescriber culture is likely an influential determinant of postoperative opioid provision. Emphasis on patient and prescriber education regarding the risks of prescription opioids and their potential long-term sequelae is key if we wish to change modifiable prescriber behavior.

Keywords: Fracture; Opioid; Postoperative prescribing.