A Cross-Cultural Comparison of Opioid Prescribing Patterns in Orthopaedic Trauma
Jason D. Young BS1, Abhiram R. Bhashyam MD2, Rameez A Qudsi MD, MPH2, Robert L. Parisien MD3, Swastina Shrestha MS4, Quirine Van der Vliet MD, MSc5, Jacky Fils MD, MPH6, Elena Losina PhD4, George S.M. Dyer MD4
1Harvard Medical School, Boston, MA, USA 2Harvard Combined Orthopaedic Residency Program, Boston, MA, USA 3Boston University Medical Center, Boston, MA, USA 4Brigham and Women's Hospital, Boston, MA, USA 5University Medical Center Utrecht, Utrecht, Netherlands 6Boston Children's Hospital, Boston, MA, USA
Background: The extent of variation in international analgesic prescribing following musculoskeletal trauma is poorly understood. Therefore, our study aimed to evaluate how opioid prescribing by orthopaedic residents varies by geographic context.
Methods: We surveyed orthopaedic residents in 3 countries (Haiti, Netherlands and United States) utilizing clinical trauma case scenarios. We standardized opioid prescriptions by conversion to Morphine Milligram Equivalents (MMEs) and constructed multivariable regressions with consideration to country, gender, training year and site of injury.
Results: U.S. resident physicians prescribed more total opioids per case (382.8, CI: 330.8-434.8), Netherlands 228.5 (CI: 160.3-296.6), Haiti 100.9 (CI: 52.2-149.6, p<0.0001). Consistent patterns were demonstrated when stratified by anatomic site of injury. Femur: U.S. 452.2 (CI: 384.8-519.6), Netherlands 314.9 (CI: 215.9-413.8) and Haiti 102.9 (CI: 37.0-168.7]). Tibial Plateau: U.S. 459.4 (CI: 388.1-530.6), Netherlands 280.1 (CI: 195.5-364.6) and Haiti 114.4 (CI: 46.3-182.5). Tibial Shaft: U.S. 440.1 (CI: 380.1-500.0), Netherlands 293.9 (CI: 205.3-382.6) and Haiti 141.4 (CI: 44.3-238.5). Wrist: U.S. 238.5 (CI: 193.5-283.5), Netherlands 77.7 (CI: 36.2-119.2) and Haiti 62.7 (CI: 30.2-95.2). Ankle: U.S. 331.4 (CI: 270.3-392.6), Netherlands 189.7 (CI: 99.5-279.8) and Haiti 85.4 (CI: 42.3-128.4, p=0.0272). Higher opioid prescriptions were observed among U.S. prescribers for patients <40 (432.1, CI: 374.0-490.1) versus those >70 (327.2, CI: 270.1-384.3) with P = 0.0019.
Conclusion: Our results demonstrate greater post-operative opioid prescribing in the U.S. as compared to one low-income and one high-income country. These findings highlight the need to critically evaluate domestic reliance on opioids and to explore alternative methods of pain management utilized in other countries.
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