Patient and surgical factors affect postoperative opioid prescription for orthopaedic trauma patients undergoing single-admission, single-surgery fracture fixation: a retrospective cohort study

Background: The authors sought to determine patient and surgical factors associated with increased postoperative opioid prescription requirements as an inpatient, during the first 6 wk, and beyond 6 wk for orthopaedic trauma patients undergoing single-admission, single-surgery fracture fixation. Methods: Two hundred patients who underwent fixation of isolated fractures (pelvis n=50, hip n=50, periarticular n=50, long bone n=50) were included in the study. Multivariate regression modeling was utilized to determine predictors of inpatient opioid usage. Results: Patients were prescribed an average of 7.9±9.1 5-milligram (mg) pills of oxycodone during the last 24 hr of inpatient opioid administration, 131±132.1 pills during 6-week outpatient period, and 23 (11%) patients continued to be prescribed opioids beyond 6 wk. Twenty-nine (14.5%) patients received opioids from a provider other than the treating surgeon or emergency department. Seventy-eight (39%) patients received at least one additional prescription for opioids after the initial discharge prescription. Predictors of increased inpatient opioid requirements during the last 24 hr were: younger age, baseline opioid use, longer length of surgery, and tobacco use. Predictors of higher 6-week outpatient opioid prescription amounts were younger age, increased operative time, baseline opioid use, unemployment, pelvic fractures, and inpatient opioid use during the 24 hr before discharge. Baseline opioid use, tobacco use, and pelvic fracture were all independent risk factures for opioid prescription beyond the 6-week follow-up period. Conclusions: Opioid use and prescription for orthopaedic trauma patents following single-admission, single-surgery fracture fixation is strongly predicted by surgical and patient factors. Level of Evidence: Level III.