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25-04-2024 | Opioids | Orthopaedic Surgery

Managing an epidemic within a pandemic: orthopedic opioid prescribing trends during COVID-19

Authors: Justin J. Turcotte, Jane C. Brennan, Andrea H. Johnson, Paul J. King, James H. MacDonald

Published in: Archives of Orthopaedic and Trauma Surgery

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Abstract

Introduction

In response to the opioid epidemic, a multitude of policy and clinical-guideline based interventions were launched to combat physician overprescribing. However, the sudden rise of the Covid-19 pandemic disrupted all aspects of healthcare delivery. The purpose of this study was to evaluate how opioid prescribing patterns changed during the Covid-19 pandemic within a large multispecialty orthopedic practice.

Materials and methods

A retrospective review of 1,048,559 patient encounters from January 1, 2015 to December 31, 2022 at a single orthopedic practice was performed. Primary outcomes were the percent of encounters with opioids prescribed and total morphine milligram equivalents (MMEs) per opioid prescription. Differences in outcomes were assessed by calendar year. Encounters were then divided into two groups: pre-Covid (1/1/2019-2/29/2020) and Covid (3/1/2020-12/31/2022). Univariate analyses were used to evaluate differences in diagnoses and outcomes between periods. Multivariate analysis was performed to assess changes in outcomes during Covid after controlling for differences in diagnoses. Statistical significance was assessed at p < 0.05.

Results

The percentage of encounters with opioids prescribed decreased from a high of 4.0% in 2015 to a low of 1.6% in 2021 and 2022 (p < 0.001). MMEs per prescription decreased from 283.6 ± 213.2 in 2015 to a low of 138.6 ± 100.4 in 2019 (p < 0.001). After adjusting for diagnoses, no significant differences in either opioid prescribing rates (post-COVID OR = 0.997, p = 0.893) or MMEs (post-COVID β = 2.726, p = 0.206) were observed between the pre- and post-COVID periods.

Conclusion

During the Covid-19 pandemic opioid prescribing levels remained below historical averages. While continued efforts are needed to minimize opioid overprescribing, it appears that the significant progress made toward this goal was not lost during the pandemic era.
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Metadata
Title
Managing an epidemic within a pandemic: orthopedic opioid prescribing trends during COVID-19
Authors
Justin J. Turcotte
Jane C. Brennan
Andrea H. Johnson
Paul J. King
James H. MacDonald
Publication date
25-04-2024
Publisher
Springer Berlin Heidelberg
Published in
Archives of Orthopaedic and Trauma Surgery
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI
https://doi.org/10.1007/s00402-024-05329-y