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Research Mentor Name

Dr. Mahjabeen Waris

Research Mentor Email Address

mwaris2@hfhs.org

Institution / Department

Henry Ford Health System - Department of Orthopedic Surgery

Document Type

Research Abstract

Research Type

clinicalresearch

Level of Research

yes

Type of Post-Bachelor Degree

MD

Abstract

Introduction

This study aims to evaluate the impact that an urban multi-center trauma department’s previous narcotic prescription protocols have had on provider opioid prescription patterns and the effect a change in protocol will have. This study will also determine an optimal post-op opioid prescription duration for ankle fracture repair surgery.

Methods

Data were collected retrospectively. CPT codes were used to identify subjects who had undergone lateral malleolus repair surgery. Patient data were separated by the respective year of their repair surgery from January 2016 to October 2020. PROMIS survey results and pain VAS scores were collected in the hospital’s electronic medical record system. Continuous data were presented as a mean, and significance was determined by an independent t-test between two groups and a one-way ANOVA test for three groups. The data was collected from January 1, 2016, to October 2, 2020.

Results

A total of 288 patients were enrolled in the study with a mean age of 44.7. There were 163 females (56.6%) in this study. The years were demographically similar for age, gender, and race/ethnicity. The mean morphine milligram equivalent (MME) per prescription decreased each year from 483.35 (2016), 417.04 (2017), 283.16 (2018), 248.22 (2019), to 145.51 (2020). The mean prescription duration also decreased each year from 103.19 days (2016), 90.12 (2017), 65.20 (2018), 30.65 (2019), to 20.74 days (2020). Furthermore, the number of prescriptions per patient and the number of pills prescribed per patient decreased each year as well. The rate of oxycodone-acetaminophen, tramadol, and acetaminophen-codeine prescriptions decreased over the years, while hydrocodone-acetaminophen prescription rates were not affected. Interestingly, the 1 month post-operative visual-analog pain score increased almost each year over the 5-year period from 3.62 (2016), 3.68 (2017), 3.93 (2018), 4.52 (2019), to 4.09 (2020) with no statistically significant differences between any of the years. PROMIS scores were only available from 2018-2020, and the 1-month post-operative physical PROMIS scores decreased significantly from 2018 to 2019 (p<0.05). Several factors were found to correlate with prescription patterns such as smoking, ethnicity, anxiety, arthritis, history of opioid use, insurance status, and type of opioid.

Conclusion

This study demonstrates that an opioid prescription protocol established in an orthopedic trauma clinic can lead to decreased opioid prescription rates, decreased MME per prescription, and decreased opioid prescription duration. Interestingly, although overall MME significantly decreased from 2016-2020, there was also a minor trend toward increased pain perception. Several demographic and socioeconomic factors were shown to correlate with prescription patterns.

Disciplines

Medicine and Health Sciences

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