• Michael T Torchia, Jeffrey Munson, Tor D Tosteson, Tosteson Anna N A ANA Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel, Qianfei Wang, Christine M McDonough, Tamara S Morgan, Bynum Julie P W JPW Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel S, and John-Erik Bell.
• Department of Orthopedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
• J Am Med Dir Assoc. 2019 Mar 1; 20 (3): 298-304.

ObjectivesFractures of the hip, distal radius, and proximal humerus are common in the Medicare population. This study's objective was to characterize patterns and duration of opioid use, including regional variations in use, after both surgical and nonoperative management.DesignPopulation-based cohort study.Setting And ParticipantsA cohort of opioid-naïve community-dwelling US Medicare beneficiaries who survived a hip, distal radius, or proximal humerus fracture between January 1, 2007 and December 31, 2010. Cohort members were required to be opioid-naïve for 4 months prior to fracture.MeasuresWe analyzed the proportion of patients with an active opioid prescription in each month following the index fracture, and report continued fills at 12 months postfracture. We also compared opioid prescription use in fractures treated surgically and nonsurgically and characterized state-level variation in opioid prescription use at 3 months postfracture.ResultsThere were 91,749 patients included in the cohort. Hip fracture patients had the highest rate of opioid use at 12 months (6.4%), followed by proximal humerus (5.7%), and distal radius (3.7%). Patients who underwent surgical fixation of proximal humerus and wrist fractures had higher rates of opioid use in each of the first 12 postoperative months compared with those managed nonoperatively. There was significant variation of opioid use at the state level, ranging from 7.6% to 18.2% of fracture patients filling opioid prescriptions 3 months after the index fracture.Conclusions/ImplicationsOpioid-naïve patients sustaining fragility fractures of the hip, proximal humerus, or distal radius are at risk to remain on opioid medications 12 months after their index injury, and surgical management of proximal humerus and distal radius fractures increases opioid use in the 12 months after the index fracture. There is significant state-level variation in opiate consumption after index fracture in nonvertebral geriatric fragility fractures. Opportunity exists for targeted quality improvement efforts to reduce the variation in opioid use following common geriatric fragility fractures.Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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