Opioid use for a first-incident upper extremity fracture in 220,440 patients without recent prior use in Ontario, Canada: a retrospective cohort study

Joy C MacDermid; J Andrew McClure; Lucie Richards; Kenneth J Faber; Susan Jaglal

doi:10.1097/OI9.0000000000000202

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 Int. 2022 Jul 7;5(3):e202. doi: 10.1097/OI9.0000000000000202. eCollection 2022 Sep.

Authors

Joy C MacDermid¹, J Andrew McClure², Lucie Richards², Kenneth J Faber³, Susan Jaglal⁴

Affiliations

¹ Departments of Surgery and Physical Therapy, University of Western Ontario and Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care.
² Institute for Clinical Evaluative Sciences Western.
³ Department of Surgery, University of Western Ontario and Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London.
⁴ Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada.

Abstract

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.

Keywords: epidemiology; fractures; opioid; upper extremity.