Scientific article
Opioid Consumption Following Outpatient Upper Extremity Surgery

https://doi.org/10.1016/j.jhsa.2012.01.035Get rights and content

Purpose

After elective outpatient upper extremity surgery, patients' need for opioid analgesic medication may be considerably less than typically dispensed. Our goal for this study was to evaluate pain control and quantify the amount of leftover pain medication.

Methods

We recruited patients scheduled for elective outpatient upper extremity surgery, who met the inclusion criteria, to participate in a phone interview 7 to 14 days after surgery. Information collected included age, gender, procedure performed, analgesic medication and regimen prescribed, satisfaction with pain control, number of tablets remaining, reasons for not taking medication, other analgesic medications used, payer classification, and any adverse drug reactions.

Results

A total of 287 eligible subjects consented to participate. Of these, 36 patients failed phone contact and 1 patient canceled surgery, which left 250 patients who completed the study. Oxycodone, hydrocodone, and propoxyphene accounted for over 95% of the prescription medications, with adequate pain control reported by 230 (92%) patients. Patients most frequently received 30 pills. Patients undergoing bone procedures reported the highest medication use (14 pills), whereas patients undergoing soft tissue procedures reported the lowest use (9 pills). Over half of the subjects reported taking the opioid medication for 2 days or less. Medicare patients consumed significantly less medication (7 pills, P < .05) than patients covered by all other types of insurance. Overall, patients consumed a mean of 10 opioid pills, whereas 19 pills per subject were reported unused, which resulted in 4,639 leftover tablets for the entire cohort.

Conclusions

Our data show that excess opioid analgesics are made available after elective upper extremity surgery and could potentially become a source for diversion. A prescription of 30 opioid pills for outpatient surgery appears excessive and unnecessary, especially for soft tissue procedures of the hand and wrist.

Type of study/level of evidence

Prognostic I.

Section snippets

Materials and Methods

This prospective cohort study examined patients from a Midwestern group of 5 private practice hand surgeons. We invited patients scheduled for elective outpatient upper extremity surgery at a freestanding outpatient surgery center from February through November 2010 to participate in the study at the time of scheduling surgery. To be included in the study, subjects had to speak English, be 18 to 90 years of age, be able to give informed consent, not be pregnant, not currently take any

Results

A total of 287 subjects were recruited and agreed to be contacted by phone within 14 days after surgery. Despite multiple attempts to contact subjects by phone, 36 patients failed to answer or respond to messages. We deemed these patients to have electively withdrawn from the study. One patient canceled surgery. We collected and analyzed information for the remaining 250 subjects. The average age of subjects recruited was 54 years. Most patients involved in the study were women; however, there

Discussion

A recently published article found that patients often do not take medications as prescribed.9 Most of our patients did not take all of their prescribed opioid analgesics, either because they were no longer in pain or because they experienced side effects. A total of 77% (193) of patients took 15 or fewer opioid analgesics, whereas 45% (113) took fewer than 5 pills and some took none at all. The total amount of unused opioid analgesics from these 250 patients was 4,639 tablets. Bates et al10

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