Opioid Prescribing Practices After Isolated Pilon Fractures

• Published in: The Journal of foot and ankle surgery Vol. 57; no. 6; pp. 1167 - 1171
• Main Authors: Rodriguez-Buitrago, Andres, Attum, Basem, Enata, Nichelle, Evans, Adam, Obremskey, William, Sethi, Manish, Jahangir, Alex
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2018
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analgesics, Opioid - therapeutic use; Ankle Fractures - complications; Ankle Fractures - therapy; Female; Fracture Fixation - adverse effects; Humans; Male; Middle Aged; opiates; orthopedic trauma; pain management; Pain, Postoperative - drug therapy; Pain, Postoperative - etiology; pilon fracture; Practice Patterns, Physicians; Retrospective Studies; Young Adult; pain management; 3; pilon fracture; orthopedic trauma; opiates
• DOI: 10.1053/j.jfas.2018.06.010
• ISSN: 1067-2516

The purpose of our study was to identify the opioid-prescribing practices after operative treatment of isolated pilon fractures at a level 1 trauma center. Patients ≥ 18 years of age with an operatively treated isolated pilon fracture between 2005 and 2015 were identified. Total morphine milligram equivalents (MMEs) were then calculated. Mean and standard deviations were calculated for patients without a history of opiate use and for patients with a history of opiate use within 1 year prior to injury. Data were obtained from the State Controlled Substance Monitoring Database. Seventy-two patients met our inclusion criteria; of these, 54% (39/72) were opiate exposed at the time of injury. Median MMEs prescribed were 2738 (range 375 to 12,360). Orthopedic providers prescribed 61% of all the MMEs (median 2010; range 113 to 6825), while nonorthopedic providers prescribed a median of 338 MMEs (range 0 to 10,080) (p < .05). Combined, patients with exposure 1 year before the injury received more MMEs (median 3600; range 840 to 12,360) than opiate-naive patients (median 2520; range 375 to 10,610) (p < .05). Twenty-eight (38.9%) patients continued using opiates for more than 6 months after their injury; 25% (7/28) were not previously exposed. There is great variability regarding the quantity of opiates being prescribed after isolated pilon fractures, and 39% of opiate prescriptions are coming from nonorthopedic prescribers. Opiate-exposed patients are more likely to be prescribed more opiates by orthopedists and outside physicians and for a longer duration. We believe that adequate pain control can be obtained by prescribing 40 pills of oxycodone 10 mg with a maximum of 1 additional refill. In cases in which a staged procedure is planned, an additional refill is expected (total of 3 refills).