Post-operative Opioid, Benzodiazepine and Sedative Usage in Medicare versus Commercial Insurance Hand Surgery Patients

Document Type : RESEARCH PAPER


1 The Rothman Institute, Hand and Upper Extremity Surgery, Philadelphia, PA, USA

2 Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, PA, USA


Background: Opioid usage has increased in recent years. The purpose of this study is to assess post-operative
opioid, sedative, and benzodiazepine usage in a Medicare population.
Methods: Consecutive patients undergoing elbow, wrist, and hand surgery by hand surgeons at one academic
outpatient surgical center were prospectively enrolled. Patients were excluded if they were minors or if they underwent
more than one surgical procedure during the study period. There were 269 patients enrolled, and this group was divided
by insurance type into younger commercial insurance (CI) and older Medicare (MC) groups.
The Pennsylvania Physician Drug Monitoring Program website was used to document all prescriptions of controlled
substances filled six months prior to and after the surgical procedure.
Results: The mean age in the CI group was 45.8 years (range: 16-88) and 69.2 years (range: 43-91) in the MC group.
Postoperatively, the CI patients filled significantly less opioid prescriptions than the MC group, 1.10 vs. 1.79. Patients in
the CI group were given an average of 0.3 benzodiazepine prescriptions before surgery and 0.2 after surgery. Patients
in the MC group were given 0.6 prescriptions before and 0.5 prescriptions of benzodiazepines after surgery. The CI
group was given an average of 0.1 sedative/hypnotic prescriptions before surgery and 0.1 after surgery. The MC group
was given 0.7 prescriptions before and 0.4 prescriptions of sedative/hypnotics after surgery.
There were 0.17 prescriptions per patient in the CI group and 0.75 per patient in the MC group (P <.05). Twenty-two
of 208 (10.6%) of CI and 16/61 (26.2%) of MC patients filled a prescription between 3-8 months post-operatively.
Conclusion: Prolonged use of opioid, benzodiazepine and sedative medications is common after upper extremity
surgical procedures. Older patients are also at risk, and may be even more likely than younger patients to use these
medications post-operatively.
Level of evidence: III


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