title: A Prospective Evaluation of Opioid Utilization After Upper-Extremity Surgical Procedures: Identifying Consumption Patterns and Determining Prescribing Guidelines.
abstract: BACKGROUND
  Although adequate management of postoperative pain with oral analgesics is an important aspect of surgical procedures, inadvertent overprescribing can lead to excess availability of opioids in the community for potential diversion. The purpose of our study was to prospectively evaluate opioid consumption following outpatient upper-extremity surgical procedures to determine opioid utilization patterns and to develop prescribing guidelines.
  
  
  METHODS
  All patients undergoing outpatient upper-extremity surgical procedures over a consecutive 6-month period had the following prospective data collected: patient demographic characteristics, surgical details, anesthesia type, and opioid prescription and consumption patterns. Analysis of variance and post hoc comparisons were performed using t tests, with the p value for multiple pairwise tests adjusted by the Bonferroni correction.
  
  
  RESULTS
  A total of 1,416 patients with a mean age of 56 years (range, 18 to 93 years) were included in the study. Surgeons prescribed a mean total of 24 pills, and patients reported consuming a mean total of 8.1 pills, resulting in a utilization rate of 34%. Patients undergoing soft-tissue procedures reported requiring fewer opioids (5.1 pills for 2.2 days) compared with fracture surgical procedures (13.0 pills for 4.5 days) or joint procedures (14.5 pills for 5.0 days) (p < 0.001). Patients who underwent wrist surgical procedures required a mean number of 7.5 pills for 3.1 days and those who underwent hand surgical procedures required a mean number of 7.7 pills for 2.9 days, compared with patients who underwent forearm or elbow surgical procedures (11.1 pills) and those who underwent upper arm or shoulder surgical procedures (22.0 pills) (p < 0.01). Procedure type, anatomic location, anesthesia type, age, and type of insurance were also all significantly associated with reported opioid consumption (p < 0.001).
  
  
  CONCLUSIONS
  In this large, prospective evaluation of postoperative opioid consumption, we found that patients are being prescribed approximately 3 times greater opioid medications than needed following upper-extremity surgical procedures. We have provided general prescribing guidelines, and we recommend that surgeons carefully examine their patients' opioid utilization and consider customizing their opioid prescriptions on the basis of anatomic location and procedure type to prescribe the optimal amount of opioids while avoiding dissemination of excess opioids.
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Jonas L
authors.initials: JL
authors.lastname: Matzon
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Jack
authors.initials: J
authors.lastname: Abboudi
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Christopher
authors.initials: C
authors.lastname: Jones
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: William
authors.initials: W
authors.lastname: Kirkpatrick
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Charles F
authors.initials: CF
authors.lastname: Leinberry
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Frederic E
authors.initials: FE
authors.lastname: Liss
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Lutsky
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Wang
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania.
authors.forename: Mitchell
authors.initials: M
authors.lastname: Maltenfort
authors.affiliation: Rothman Institute at the Thomas Jefferson University, Philadelphia, Pennsylvania asif.ilyas@rothmaninstitute.com.
authors.forename: Asif M
authors.initials: AM
authors.lastname: Ilyas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects*; D010149:Postoperative Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D034941:Upper Extremity / Q000601:surgery*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid