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

Document Type : RESEARCH PAPER

Authors

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

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

Abstract

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

Keywords

References

1. Kuehn BM. Opioid prescriptions soar: increase
in legitimate use as well as abuse. JAMA.
2007;297(3):249-51.
2. Manchikanti L, Helm Ii S, Fellows B, Janata JW, Pampati
V, Grider JS, et al. Opioid epidemic in the United
States. Pain physician. 2012; 15(3 Suppl):ES9-38.
3. Chapman T, Kim N, Maltenfort M, Ilyas AM.
Prospective Evaluation of Opioid Consumption
Following Carpal Tunnel Release Surgery. Hand (N
Y). 2017;12(1):39-42.
4. Rodgers J, Cunningham K, Fitzgerald K, Finnerty
E. Opioid consumption following outpatient upper
extremity surgery. J Hand Surg Am. 2012;37(4):645-50.
5. Florence CS, Zhou C, Luo F, Xu L. The Economic
Burden of Prescription Opioid Overdose, Abuse, and
Dependence in the United States, 2013. Med Care.
2016;54(10):901-6.
6. Jiang X, Orton M, Feng R, Hossain E, Malhotra NR, 
Zager EL, et al. Chronic Opioid Usage in Surgical
Patients in a Large Academic Center. Ann Surg.
2017;265(4):722-7.
7. Johnson SP, Chung KC, Zhong L, Shauver MJ,
Engelsbe MJ, Brummett C, et al. Risk of Prolonged
Opioid Use Among Opioid-Naive Patients Following
Common Hand Surgery Procedures. J Hand Surg Am.
2016;41(10):947-57 e3.
8. Schoenfeld AJ, Nwosu K, Jiang W, Yau AL, Chaudhary
MA, Scully RE, et al. Risk Factors for Prolonged Opioid
Use Following Spine Surgery, and the Association
with Surgical Intensity, Among Opioid-Naive Patients.
J Bone Joint Surg Am. 2017;99(15):1247-52.
9. Cryar KA, Hereford T, Edwards PK, Siegel E, Barnes
CL, Mears SC. Preoperative Smoking and Narcotic,
Benzodiazepine, and Tramadol Use are Risk Factors
for Narcotic Use After Hip and Knee Arthroplasty. J
Arthroplasty. 2018. 
The Archives of Bone and Joint Surgery
Volume 9, Issue 3
May 2021
Pages 319-322

Files

History

  • Receive Date: 18 May 2020
  • Revise Date: 11 July 2020
  • Accept Date: 19 August 2020

Share

How to cite

Statistics