Variability in opioid prescribing following fracture fixation: A retrospective cohort analysis

Background: We quantified variability in opioid prescriptions for orthopaedic trauma patients at an academic level 1 trauma center and examined patient, prescriber, and injury factors associated with prescription practices. Methods: Patients with malleolar, diaphyseal tibia, plateau, proximal femur, and forearm fractures at a level 1 trauma center were identified retrospectively. The number of opioid pills prescribed at discharge, demographics, and prescriber (MD vs. APP) data were collected. Statistical analysis was done to compare opioid prescription with injury location, patient, and prescriber data. Multivariate linear regression analysis was performed to examine factors associated with opioid prescribing. Results: One hundred and one patients were included in the study. Discharge prescriptions had a mean of 60 oxycodone 5 mg pill equivalents (OEQ) for all patients, with a standard deviation of 33 pill equivalents and a coefficient of variation of 56%. Older patients received fewer opioids compared to younger patients (P=0.008). Patients treated for tibial plateau fractures received more opioids compared to other fractures types (76 vs. 60 pill equivalents, P=0.03). In the multivariate analysis, older age was associated with lower prescribing, whereas a tibial plateau fracture was associated with higher prescribing. Physicians were more likely to prescribe low numbers of narcotics (<10th percentile) compared to advance practice practitioners (APPs) (P=0.04). Conclusions: There was high variability in opioid prescribing practices after fracture fixation. Patients with plateau fractures received more opioids, while older patients received fewer. Physicians were less likely to overprescribe than APPs. This highlights opportunities for a postoperative pain protocol to minimize overprescription of opioids. Level of Evidence: Level IV.