Perioperative Opioid Prescriptions in Patients on Oral Anticoagulants Undergoing Elective Soft Tissue Hand Surgery.

PURPOSE: Oral anticoagulation use is increasing in prevalence in the hand surgery population and poses a challenge for perioperative pain management, given the relative contraindication of nonsteroidal anti-inflammatory drug use. Anticoagulated patients may be prescribed opioids after hand surgery, leading to opioid use-related risks. In this study, we tested the hypothesis that preoperative oral anticoagulant use was associated with the incidence of perioperative opioid prescriptions in opioid-naive patients undergoing elective soft tissue hand surgery.

METHODS

We identified opioid-naive adult patients undergoing carpal tunnel/trigger finger/DeQuervain release or hand/wrist mass excision using a national administrative claims database. Patients with preoperative oral anticoagulant prescriptions were propensity score-matched to those without. Oral anticoagulants were subdivided into direct oral anticoagulants (apixaban, rivaroxaban, dabigatran, and edoxaban) or warfarin. The primary outcome was the incidence of perioperative opioid prescriptions. The incidence of postoperative emergency department (ED) visits was measured as a secondary outcome. Multivariable logistic regression models were used to evaluate the association between perioperative opioid prescription and ED visits, adjusting for age, sex, region, insurance plan, and Elixhauser comorbidity index.

RESULTS

After propensity score matching, patients with preoperative oral anticoagulant prescriptions were more likely to be prescribed perioperative opioids (odds ratio, 1.77 [1.60-1.96] for direct oral anticoagulants, odds ratio: 1.59 [1.42-1.77]) for warfarin. The most commonly prescribed opioids were hydrocodone with acetaminophen and tramadol. Being prescribed perioperative opioids was not associated with an increased incidence of postoperative ED visits.

CONCLUSIONS

Preoperative oral anticoagulant use was associated with an increased incidence of perioperative opioid prescriptions in patients undergoing elective soft tissue hand surgery.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.