Psychological resilience as a predictor of opioid consumption after orthopaedic trauma

INTRODUCTION

Psychological distress after orthopaedic trauma negatively affects patient outcomes. Resilience may mediate distress and therefore be associated with post-operative outcomes, including opioid use. The purpose of this study is to evaluate the relationship between resilience and post-operative opioid demand with the hypothesis that low levels of resilience are associated with increased opioid consumption.

MATERIALS AND METHODS

Patients age 18 - 65 at a single, tertiary care level 1 trauma center who underwent operative treatment of pelvic and/ or extremity fractures between 3/2017 - 6/2018 were contacted by phone to complete the OSPRO-YF, a ten-item screening tool that assesses psychological distress. Participants were screened for scores in the worst quartile (i.e., yellow flag) for resilience. Baseline patient and injury characteristics and opioid demand were compared between patients with and without positive yellow flags for resilience using Wilcoxon rank-sum for continuous variables and Fisher exact test for categorical variables.

RESULTS

A total of 117 patients were surveyed. Patients with positive yellow flag screening scores for resilience had significantly higher opioid demand, number of opioid prescriptions filled, and were more likely to refill prescriptions long-term (3-months post-discharge to one-year post-discharge). Patients with a positive yellow flag for resilience had a significantly higher number of opioid prescriptions filled in the cumulative (one-month pre-op to one-year post-discharge) time period.

DISCUSSION/ CONCLUSION

Lower long-term resilience scores were associated with higher postoperative opioid consumption, fill and refill rates. These results suggest low resilience may be a risk factor for increased long-term opioid consumption following surgical treatment for orthopaedic trauma.

Regional anesthesia does not decrease inpatient or outpatient opioid demand in femoral shaft fracture surgery

INTRODUCTION

Regional anesthesia (RA) may be used in femoral shaft fracture surgery to decrease pain and opioid consumption. However, the impact of RA on inpatient and outpatient opioid demand in patients undergoing femoral shaft fracture surgery is largely unknown. The aim of this study was to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand in patients undergoing femoral shaft fracture surgery.

METHODS

Inpatient opioid consumption and outpatient opioid demand in all patients undergoing femoral shaft fracture surgery was recorded at a single, Level I trauma center from 7/2013 - 7/2018 (n=436). In addition to RA, baseline and treatment factors including age, sex, race, body mass index (BMI), smoking, chronic opioid use, American Society of Anesthesiologists (ASA) score, injury mechanism, additional injuries, open injury, and additional inpatient surgery were recorded. Unadjusted and adjusted multivariable models were used to evaluate the impact of RA on inpatient opioid consumption and outpatient opioid demand.

RESULTS

Adjusted models demonstrated increases in inpatient opioid consumption in patients with RA (6.9 estimated OE's without RA vs 8.8 OE's with RA from 48-72 hours post-op, p<0.05) but no significant differences at other timepoints (10.3 estimated OE's without RA vs 9.2 OE's with RA from 0-24 hours post-op, 8.2 vs 8.8 from 24-48 hours post-op, p>0.05). Estimated cumulative outpatient opioid demand did not differ significantly in patients with RA (82.3 OE's without RA vs 94.8 with RA from discharge to two-weeks, 105.4 vs 116.3 OE's to 6-weeks, and 124.5 vs 137.9 OE's to 90-days, all p>0.05). Late opioid refills were significantly more common in patients with RA (1.57 odds at 2-weeks to 6-weeks, 1.69 odds at 6-weeks to 90-days, p<0.05) DISCUSSION: In femoral shaft fracture surgery, RA was not associated with decreased opioid demand after adjusting for baseline patient and treatment characteristics. These results provide a real-world estimate of the impact of RA on opioid demand in femoral shaft fracture surgery and encourage providers to seek alternative analgesic modalities.

LEVEL OF EVIDENCE

Level III, retrospective, therapeutic cohort study.

Regional anesthesia improves inpatient but not outpatient opioid demand in tibial shaft fracture surgery

BACKGROUND

Patients undergoing operative treatment of tibial shaft fractures have considerable pain largely managed with opioids. Regional anesthesia (RA) has been increasingly used to reduce perioperative opioid use.

METHODS

This was a retrospective study of 426 patients that underwent operative treatment of tibial shaft fractures with and without RA. Inpatient opioid consumption and 90-day outpatient opioid demand were measured.

RESULTS

RA significantly decreased inpatient opioid consumption for 48 h post-operatively (p = 0.008). Neither inpatient use after 48 h nor outpatient opioid demand differed in patients with RA (p > 0.05).

CONCLUSIONS

RA may help with inpatient pain control and reduce opioid use in tibial shaft fracture.

LEVEL OF EVIDENCE

Level III, retrospective, therapeutic cohort study.