Evidence map›Paper›PMID 30570619›Full record

ArticleJournal of orthopaedic trauma2019

Using Historical Variation in Opioid Prescribing Immediately After Fracture Surgery to Guide Maximum Initial Prescriptions.

Abhiram R Bhashyam, Matthew Basilico, Michael J Weaver, Mitchel B Harris, Marilyn Heng

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In one paragraph

Article in Journal of orthopaedic trauma, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05322564 (Standardization of Post-operative Opiate Prescriptions for Same-day Ankle and Wrist Fracture Surgeries), which is not on this map. Cited by 9 papers.

0numbers the graph read from it
0cells of the map it votes in
9citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT05322564 naunknown statusnot on this mapstarted 2022, after this paper: background citation

Standardization of Post-operative Opiate Prescriptions for Same-day Ankle and Wrist Fracture Surgeries

TypeinterventionalSponsorThe Ottawa HospitalRan2022 to 2022Enrolled100ConditionsOpioid Use, Post-operative Pain, Prescription Opioid Abuse, Fracture, AnkleArmsStandardized opiate prescription
3 · Its place in the literature

Who cites it

9 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Abhiram R BhashyamHarvard Combined Orthopaedics Residency Program, Boston, MA.
Matthew BasilicoDepartment of Economics, Harvard University and Harvard Medical School, Boston, MA.
Michael J WeaverDepartment of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA.
Mitchel B HarrisDepartment of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA.
Marilyn HengDepartment of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA.

Funding

MD-PhD Training Program in Aging and the Social/Behavioral SciencesT32AG051108 · NIA · HARVARD MEDICAL SCHOOL · PI MCWILLIAMS, JOHN MICHAEL · 2015 to 2025
$2.1M
NIA NIH HHS T32 AG051108
6 · The paper itself

Abstract

objectivesRecent studies have advocated for prescription opioid maximums (based on percentage reductions from historical amounts) to reduce excess prescribing. Implementing this in orthopaedic trauma has been difficult, given the injury variety and limited historical data on postoperative prescribing. We report on the initial opioid prescriptions for a large cohort of postoperative, opiate-naive fracture patients and hypothesize that prescribing was associated with fracture location and morphology.

designRetrospective cohort analysis.

settingTwo American College of Surgeons Level I trauma centers. PATIENTS: Six thousand eight hundred seventy-nine orthopaedic trauma patients treated between 2002 and 2015. Only patients who had a single operatively treated injury and were opiate naive (had not received an opioid prescription in the 6 months before presentation) were included.

interventionPostoperative opioid discharge prescription. OUTCOMES: We analyzed the quantity of initial opioids prescribed in morphine milligram equivalents (MMEs, a standardized unit of opioid dosage used for comparison across opioid types). Fracture location and morphology were classified using the OTA/AO classification.

resultsFracture location was an independent predictor of the MME prescribed (P < 0.001). All other fracture locations were prescribed significantly higher MME than distal radius fractures (control group, 150 MME, P < 0.01). There was no difference in MMEs prescribed by articular involvement or degree of comminution.

conclusionsWe demonstrate significant variation in initial postoperative opioid prescribing to opiate-naive orthopaedic trauma patients by fracture location, but not by fracture morphology. We use these data to propose a guideline based on the OTA/AO fracture classification for the maximum initial prescription of opioids. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Indexed as

AdultAgedAnalgesics, OpioidCohort StudiesDrug PrescriptionsFemaleFractures, BoneHumansMaleMiddle AgedOrthopedic ProceduresPostoperative PainPrescription Drug OveruseRetrospective StudiesAnalgesics, Opioid

Identifiers

PMID30570619
PMCPMC6599458

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.