SLR - September 2021 - Blake T. Savage

Factors Associated with Perioperative Opioid Demand in Lower Extremity Fractures: Does consumption vary by anatomic location?

Reference: Cunningham D, LaRose M, Yoon RS, Gage MJ. Factors associated with perioperative opioid demand in lower extremity fractures: Does consumption vary by anatomic location? Injury. 2021 Jun;52(6):1363-1369.

Level of Evidence: IV

Scientific Literature Review

Reviewed By: Blake T. Savage, DPM
Residency Program: SSM Health DePaul Hospital – St. Louis, MO

Podiatric Relevance: Traumatic orthopedic injuries may require several surgeries as part of the treatment protocol. Provisional external fixation followed by definitive fixation is common. The aim of the study was to evaluate the influence of fracture location, articular injury, and provisional fixation on perioperative opioid demand following definitive fixation.

Methods: The authors performed a retrospective study evaluating opioid use of oxycodone 5mg equivalents in 23,441 patients throughout three time periods using a national database. The first time period was 30 days preoperative to 90 days post operatively. Second, three months to one year post op discharge. Third, one-month pre op to one year post op discharge. Multivariable linear and logistic regression models were performed to evaluate opioid volume, number of prescriptions, and prescription refills in relation to fracture location, articular injury and preoperative external fixation placement. .

Results: The highest amount of opioid prescription filling was present in cohorts with pilon fractures and those who required provisional external fixation. These groups had an increase in the odds of refills of two or more within the first month preoperative to one-year post-operative state period.

Conclusions: Intra-articular fractures carry an inherent risk of increased pain and disability as well as rapid progression to osteoarthritis. Those with tibial plateau and pilon fractures had the highest risk of larger opioid consumption. An assumption of over-prescribing was acknowledged but little data exists on the actual estimates.  

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