Post-operative opioid pain management patterns for patients who receive hip surgery.

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2017-03-16

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Abstract

Identifying optimal, post-operative opioid management strategies is a priority of health providers and government agencies. At present, there are no studies we are aware of that have formally investigated opioid prescribing patterns for post-operative non-arthroplasty orthopedic conditions such as femoroacetabular impingement, nor has any study investigated the influence of opioid prescription patterns on health care costs and utilization. We aimed to investigate a subgrouping scheme associated with post-operative opioid prescription strategies and measure the subgroups' direct and indirect health care utilization and costs in individuals undergoing non-arthroplasty orthopedic hip surgery.The study was an observational cohort of routine military clinical practices. We used cluster analysis to characterize pre-operative (12 months) and post-operative (24 months) opioid prescription patterns. Linear mixed effects modeling (with statistical controls for baseline status) identified opioid prescription pattern subgroups and identified subgroup differences in health care utilization and costs.Two distinct clusters were identified representing 1) short-duration, high total days' supply (SD-HD), and 2) long-duration, lesser total days' supply (LD-LD) post-operative prescription patterns. Significantly higher costs and health care utilization for both hip-related and non-hip-related variables were consistently identified in the SD-HD group.Long-term opioid prescription use has been identified as a concern, but our findings demonstrate that LD-LD post-operative opioid management for hip surgery recipients was associated with lower costs and utilization. Whether these management patterns were a reflection of pre-operative health status, impacted pain-related outcomes, or can be replicated in other orthopedic procedures remains a consideration for future studies.NA.

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10.1186/s13011-017-0094-5

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Cook, Chad E, Daniel I Rhon, Brian D Lewis and Steven Z George (2017). Post-operative opioid pain management patterns for patients who receive hip surgery. Substance abuse treatment, prevention, and policy, 12(1). 10.1186/s13011-017-0094-5 Retrieved from https://hdl.handle.net/10161/16765.

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Scholars@Duke

Cook

Chad E. Cook

Professor in Orthopaedic Surgery

Dr. Cook is a clinical researcher, physical therapist, and profession advocate with a long-term history of clinical care excellence and service. His passions include refining and improving the patient examination process and validating tools used in day-to-day physical therapist practice. Dr. Cook has authored or co-authored 3 textbooks, has published over 315 peer reviewed manuscripts and lectures internationally on orthopedic examination and treatment.

Daniel I. Rhon

Adjunct Assistant Professor in the Department of Orthopaedic Surgery
Lewis

Brian David Lewis

Associate Professor of Orthopaedic Surgery

I am an assistant professor in the department of orthopaedics.  My sub-specialty interest is in hip surgery including arthroplasty and non-arthoplasty hip surgery.  This includes the treatment of osteoarthritis, hip dysplasia, hip impingement, labral tears, as well as various tendon disorders around the hip.

The research interests include outcomes research for hip surgeries, hip movement disorders related to hip conditions, and factors influencing opioid use in post-surgical patients.


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