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

Background: Opioid usage has increased in recent years. Post-operative pain medication is implicated in contributing to long-term use, even without previous exposure to opioids. Our purpose is to assess post-operative opioid, sedative, and benzodiazepine usage in a Medicare population. Methods: Consecutive patients undergoing upper extremity surgery by hand surgeons at one academic outpatient surgical center were prospectively enrolled. Patients were excluded if they were minors or underwent multiple surgical procedures during the study period. There were 269 patients enrolled, divided by insurance type into younger commercial insurance (CI) and older Medicare (MC) groups. The Pennsylvania Physician Drug Monitoring Program website was used to assess controlled substances filled six months prior to and after the surgical procedure. Results: 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. The CI group was given an average of 0.3 benzodiazepine prescriptions before surgery and 0.2 after surgery. The MC group was given 0.6 prescriptions before and 0.5 of benzodiazepines after surgery. Patients in the CI group were given an average of 0.1 sedative/hypnotic prescriptions before surgery and 0.1 after surgery. Patients in the MC group were given 0.7 prescriptions before and 0.4 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-two of 208 (10.6%) of CI and 16/61 (26.2%) of MC patients filled a prescription between 3-8 months post-operatively. Conclusion: Prolonged use of opioid, benzodiazepine and sedative medications is common after upper extremity surgeries. Older patients are at risk, and may be more likely than younger patients to use these medications post-operatively. Keywords: Opioid, Benzodiazepine, Sedative, elderly Level of Evidence: III