Post-operative Opioid, Benzodiazepine and Sedative Usage in Medicare versus Commercial Insurance Hand Surgery Patients

Opioid usage has increased in recent years. The purpose of this study is to assess post-operativeopioid, sedative, and benzodiazepine usage in a Medicare population. Consecutive patients undergoing elbow, wrist, and hand surgery by hand surgeons at one academicoutpatient surgical center were prospectively enrolled. Patients were excluded if they were minors or if they underwentmore than one surgical procedure during the study period. There were 269 patients enrolled, and this group was dividedby insurance type into younger commercial insurance (CI) and older Medicare (MC) groups.The Pennsylvania Physician Drug Monitoring Program website was used to document all prescriptions of controlledsubstances filled six months prior to and after the surgical procedure. The mean age in the CI group was 45.8 years (range: 16-88) and 69.2 years (range: 43-91) in the MC group.Postoperatively, the CI patients filled significantly less opioid prescriptions than the MC group, 1.10 vs. 1.79. Patients inthe CI group were given an average of 0.3 benzodiazepine prescriptions before surgery and 0.2 after surgery. Patientsin the MC group were given 0.6 prescriptions before and 0.5 prescriptions of benzodiazepines after surgery. The CIgroup was given an average of 0.1 sedative/hypnotic prescriptions before surgery and 0.1 after surgery. The MC group was given 0.7 prescriptions before and 0.4 prescriptions of sedative/hypnotics after surgery.There were 0.17 prescriptions per patient in the CI group and 0.75 per patient in the MC group (P <.05). Twenty-twoof 208 (10.6%) of CI and 16/61 (26.2%) of MC patients filled a prescription between 3-8 months post-operatively. Prolonged use of opioid, benzodiazepine and sedative medications is common after upper extremitysurgical procedures. Older patients are also at risk, and may be even more likely than younger patients to use thesemedications post-operatively.Level of evidence: III