gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

The Opiod Epidemic in the US: A Method for Changing the Opioid Prescribing Habits of Surgeons

Meeting Abstract

Suche in Medline nach

  • presenting/speaker David Nelson - Greenbrae, United States

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-1991

doi: 10.3205/19ifssh0751, urn:nbn:de:0183-19ifssh07519

Veröffentlicht: 6. Februar 2020

© 2020 Nelson.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.


Gliederung

Text

Introduction: The United States represents 5% of the world's population yet accounts for 99% of the global hydrocodone (Vicodin, Norco) production. Clearly, US physicians are overprescribing opioids. Orthopedic surgeons are the highest prescribing group of US physicians, and their habits need to be changed.

Objectives:

1.
To determine what is the average, range, and nature of the opioid and other medication routinely prescribed by a US surgeon for a volar plating of a standardized surgical procedure (distal radius fracture, as determined in a prior study), and
2.
To determine if feedback of this data to the surgeon result in a change of prescribing habits

Methods: The method was to interview surgeons by email who perform ORIF of distal radius fractures using a volar plate as to their normal perioperative pain management protocol, with specific reference to the choice of opioid and how many were prescribed. Opioid prescriptions were translated into Morphine Equivalents (MEs), for comparison. Feedback was given to the surgeon how they compared to the study average in terms of MEs, choice of opioid, supplementary medication, as well as the characteristics of the highest 5 prescribers and the lowest 5 prescribers in the study. A second interview was conducted to determine if this feedback prompted the surgeon modify their pain management protocol.

Results and Conclusions: 78 surgeons completed the first interview with enough data to allow completion of the analysis. The number of opioids ranged from 5 morphine equivalents (MEs) to 160 MEs, with a mean of 46.0 and a mode of 30. The lowest 5 respondents prescribed an average of 13 MEs, usually hydrocodone, reported that their patients' pain was well-controlled, and refill requests were rare. The highest 5 respondents prescribed an average of 115 MEs and used more Dilaudid and Percocet than the group as a whole. Fear of weekend requests for opioid refills was cited as a main reason for prescribing large amounts of opioids. Upon re-interview after feedback of the results, 95% had already begun, or planned to, decrease their opioid prescription number, change to less-addictive opioids, and to increase multimodal approaches.

Using ORIF of a distal radius fracture as an index procedure, it was found that merely giving feedback to surgeons regarding how they compare to their peers is useful in prompting evaluation of their perioperative pain program and in decreasing the quantity of opioids prescribed.