title: Post-operative opioid pain management patterns for patients who receive hip surgery.
abstract: Identifying optimal, post-operative opioid management strategies is a priority of health providers and government agencies. At present, there are no studies we are aware of that have formally investigated opioid prescribing patterns for post-operative non-arthroplasty orthopedic conditions such as femoroacetabular impingement, nor has any study investigated the influence of opioid prescription patterns on health care costs and utilization. We aimed to investigate a subgrouping scheme associated with post-operative opioid prescription strategies and measure the subgroups' direct and indirect health care utilization and costs in individuals undergoing non-arthroplasty orthopedic hip surgery.
  
  
  
  The study was an observational cohort of routine military clinical practices. We used cluster analysis to characterize pre-operative (12 months) and post-operative (24 months) opioid prescription patterns. Linear mixed effects modeling (with statistical controls for baseline status) identified opioid prescription pattern subgroups and identified subgroup differences in health care utilization and costs.
  
  
  
  Two distinct clusters were identified representing 1) short-duration, high total days' supply (SD-HD), and 2) long-duration, lesser total days' supply (LD-LD) post-operative prescription patterns. Significantly higher costs and health care utilization for both hip-related and non-hip-related variables were consistently identified in the SD-HD group.
  
  
  
  Long-term opioid prescription use has been identified as a concern, but our findings demonstrate that LD-LD post-operative opioid management for hip surgery recipients was associated with lower costs and utilization. Whether these management patterns were a reflection of pre-operative health status, impacted pain-related outcomes, or can be replicated in other orthopedic procedures remains a consideration for future studies.
  
  
  
  NA.
authors.affiliation: Division of Physical Therapy, Duke University, 2200 West Main Street, Durham, NC, 27705, USA. chad.cook@duke.edu.
authors.forename: Chad E
authors.initials: CE
authors.lastname: Cook
authors.affiliation: Clinical Outcomes Research, Center for the Intrepid, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, 78234, USA.|Baylor University, Fort Sam Houston, San Antonio, TX, 78234, USA.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Rhon
authors.affiliation: Department of Orthopaedics, Duke University, Box 3389, Durham, NC, 27710, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lewis
authors.affiliation: Department of Orthopaedics, Musculoskeletal Research, Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC, 27705, USA.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D057925:Femoracetabular Impingement / Q000150:complications / Q000601:surgery; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000150:complications / Q000188:drug therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: Femoroacetabular impingement; Opioid management; Surgery