Surveys using vignette-based trauma cases that were given to residents showed those from the United States prescribed more postoperative opioids at discharge than residents from two other countries.
“[Orthopedic] residents from the United States are prescribing opioids for postoperative pain in orthopedic trauma more frequently, at higher doses, and for longer periods of time than their international counterparts,” Jason D, Young, BS, told Healio.com/Orthopedics. “Additionally, in some contexts, higher-income countries like the Netherlands are more similar to lower-income countries like Haiti in their postoperative prescribing practices (as compared to the United States).”
Researchers had orthopedic residents from three different countries respond to surveys which used the vignette-based musculoskeletal trauma case scenarios. Medications used for post discharge analgesia was chosen by the residents. Investigators noted standardized opioid prescriptions by conversion to morphine milligram equivalents. Generalized estimating equations were used to construct multivariable regressions to determine the difference in opiate prescription according to country, residents’ sex and training year and patients’ injury site and age.
Results showed residents from the United States compared with those from the Netherlands and Haiti prescribed significantly more total morphine milligram equivalents per case overall and for patients with femur, tibial plateau, tibial shaft, wrist and ankle injuries. Investigators noted residents from the United States prescribed significantly more morphine milligram equivalents for patients younger than 40 years than for those older than 70 years.
Young said, “Given the current opioid crisis, these findings ultimately point to a need to reassess the role of opioids in the management of postoperative pain. In terms of next steps, we are looking to contextualize the high opioid prescriptions domestically to see how it relates to non-opioid pain medications and multimodal analgesic prescribing patterns.” – by Monica Jaramillo
Disclosures: The authors report no relevant financial disclosures.