Opioid use for a first-incident upper extremity fracture in 220,440 patients without recent prior use in Ontario, Canada: a retrospective cohort study
Objective:. To describe opioid use for a first upper extremity fracture in a cohort of patients who did not have recent opioid use. Design:. Descriptive epidemiological study. Setting:. Emergency Department, Hospital. Patients/Participants:. We obtained health administrative data records of adults p...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2022-09-01
|
| Series: | OTA International |
| Online Access: | http://journals.lww.com/10.1097/OI9.0000000000000202 |
| _version_ | 1797671813804720128 |
|---|---|
| author | Joy C. MacDermid, PhD J. Andrew McClure, MSc Lucie Richards, MSc Kenneth J. Faber, MD MHPE, FRCSC Susan Jaglal, PhD |
| author_facet | Joy C. MacDermid, PhD J. Andrew McClure, MSc Lucie Richards, MSc Kenneth J. Faber, MD MHPE, FRCSC Susan Jaglal, PhD |
| author_sort | Joy C. MacDermid, PhD |
| collection | DOAJ |
| description | Objective:. To describe opioid use for a first upper extremity fracture in a cohort of patients who did not have recent opioid use.
Design:. Descriptive epidemiological study.
Setting:. Emergency Department, Hospital.
Patients/Participants:. We obtained health administrative data records of adults presenting with a first adult upper extremity fracture from 2013 to 2017 in Ontario, Canada. We excluded patients with previous fractures, opioid prescription in the past 6 months or hospitalization >5 days after the fracture.
Intervention:. Opioid prescription.
Main Outcome Measurements:. We identified the proportion of patients filling an opioid prescription within 7 days of fracture. We described this based on different upper extremity fractures (ICD-10), Demographics (age, sex, rurality), comorbidity (Charlson Comorbidity Index, Rheumatoid arthritis, Diabetes), season of injury, and social marginalization (Ontario Marginalization Index-a data algorithm that combines a wide range of demographic indicators into 4 distinct dimensions of marginalization). We considered statistical differences (P< .01) that reached a standardized mean difference of 10% as being clinically important (standardized mean difference [SMD] ≥ 0.1).
Results:. From 220,440 patients with a first upper extremity fracture (50% female, mean age 50), opioids were used by 34% of cases overall (32% in males, 36% in females, P< .001, SMD ≥ 0.1). Use varied by body region, with those with multiple or proximal fractures having the highest use: multiple shoulder 64%, multiple regions 62%, shoulder 62%, elbow 38%, wrist 31%, and hand 21%; and was higher in patients who had a nerve/tendon injury or hospitalization (P< .01, SMD ≥ 0.1). Social marginalization, comorbidity, and season of injury had clinically insignificant effects on opioid use.
Conclusions:. More than one-third of patients who are recent-non-users will fill an opioid prescription within 7 days of a first upper extremity fracture, with usage highly influenced by fracture characteristics.
Level of Evidence: Level II |
| first_indexed | 2024-03-11T21:20:57Z |
| format | Article |
| id | doaj.art-742eb9e9a41e4c6c9941cc8dd834ea7d |
| institution | Directory Open Access Journal |
| issn | 2574-2167 |
| language | English |
| last_indexed | 2024-03-11T21:20:57Z |
| publishDate | 2022-09-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | OTA International |
| spelling | doaj.art-742eb9e9a41e4c6c9941cc8dd834ea7d2023-09-28T07:17:22ZengWolters KluwerOTA International2574-21672022-09-0153e20210.1097/OI9.0000000000000202OI90000000000000202Opioid use for a first-incident upper extremity fracture in 220,440 patients without recent prior use in Ontario, Canada: a retrospective cohort studyJoy C. MacDermid, PhDJ. Andrew McClure, MScLucie Richards, MScKenneth J. Faber, MD MHPE, FRCSCSusan Jaglal, PhDObjective:. To describe opioid use for a first upper extremity fracture in a cohort of patients who did not have recent opioid use. Design:. Descriptive epidemiological study. Setting:. Emergency Department, Hospital. Patients/Participants:. We obtained health administrative data records of adults presenting with a first adult upper extremity fracture from 2013 to 2017 in Ontario, Canada. We excluded patients with previous fractures, opioid prescription in the past 6 months or hospitalization >5 days after the fracture. Intervention:. Opioid prescription. Main Outcome Measurements:. We identified the proportion of patients filling an opioid prescription within 7 days of fracture. We described this based on different upper extremity fractures (ICD-10), Demographics (age, sex, rurality), comorbidity (Charlson Comorbidity Index, Rheumatoid arthritis, Diabetes), season of injury, and social marginalization (Ontario Marginalization Index-a data algorithm that combines a wide range of demographic indicators into 4 distinct dimensions of marginalization). We considered statistical differences (P< .01) that reached a standardized mean difference of 10% as being clinically important (standardized mean difference [SMD] ≥ 0.1). Results:. From 220,440 patients with a first upper extremity fracture (50% female, mean age 50), opioids were used by 34% of cases overall (32% in males, 36% in females, P< .001, SMD ≥ 0.1). Use varied by body region, with those with multiple or proximal fractures having the highest use: multiple shoulder 64%, multiple regions 62%, shoulder 62%, elbow 38%, wrist 31%, and hand 21%; and was higher in patients who had a nerve/tendon injury or hospitalization (P< .01, SMD ≥ 0.1). Social marginalization, comorbidity, and season of injury had clinically insignificant effects on opioid use. Conclusions:. More than one-third of patients who are recent-non-users will fill an opioid prescription within 7 days of a first upper extremity fracture, with usage highly influenced by fracture characteristics. Level of Evidence: Level IIhttp://journals.lww.com/10.1097/OI9.0000000000000202 |
| spellingShingle | Joy C. MacDermid, PhD J. Andrew McClure, MSc Lucie Richards, MSc Kenneth J. Faber, MD MHPE, FRCSC Susan Jaglal, PhD Opioid use for a first-incident upper extremity fracture in 220,440 patients without recent prior use in Ontario, Canada: a retrospective cohort study OTA International |
| title | Opioid use for a first-incident upper extremity fracture in 220,440 patients without recent prior use in Ontario, Canada: a retrospective cohort study |
| title_full | Opioid use for a first-incident upper extremity fracture in 220,440 patients without recent prior use in Ontario, Canada: a retrospective cohort study |
| title_fullStr | Opioid use for a first-incident upper extremity fracture in 220,440 patients without recent prior use in Ontario, Canada: a retrospective cohort study |
| title_full_unstemmed | Opioid use for a first-incident upper extremity fracture in 220,440 patients without recent prior use in Ontario, Canada: a retrospective cohort study |
| title_short | Opioid use for a first-incident upper extremity fracture in 220,440 patients without recent prior use in Ontario, Canada: a retrospective cohort study |
| title_sort | opioid use for a first incident upper extremity fracture in 220 440 patients without recent prior use in ontario canada a retrospective cohort study |
| url | http://journals.lww.com/10.1097/OI9.0000000000000202 |
| work_keys_str_mv | AT joycmacdermidphd opioiduseforafirstincidentupperextremityfracturein220440patientswithoutrecentprioruseinontariocanadaaretrospectivecohortstudy AT jandrewmccluremsc opioiduseforafirstincidentupperextremityfracturein220440patientswithoutrecentprioruseinontariocanadaaretrospectivecohortstudy AT lucierichardsmsc opioiduseforafirstincidentupperextremityfracturein220440patientswithoutrecentprioruseinontariocanadaaretrospectivecohortstudy AT kennethjfabermdmhpefrcsc opioiduseforafirstincidentupperextremityfracturein220440patientswithoutrecentprioruseinontariocanadaaretrospectivecohortstudy AT susanjaglalphd opioiduseforafirstincidentupperextremityfracturein220440patientswithoutrecentprioruseinontariocanadaaretrospectivecohortstudy |