Geospatial Analyses of Pain Intensity and Opioid Unit Doses Prescribed on the Day of Discharge Following Orthopedic Surgery

Author:

Tighe Patrick1,Modave François2,Horodyski MaryBeth3,Marsik Matthew4,Lipori G4,Fillingim Roger5,Hu Hui6,Hagen Jennifer3

Affiliation:

1. Departments of Anesthesiology

2. Health Outcomes and Biomedical Informatics

3. Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, Florida

4. Data Science and Planning, University of Florida Health, Gainesville, Florida

5. Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, Florida

6. Department of Epidemiology, University of Florida College of Medicine, Gainesville, Florida, USA

Abstract

Abstract Objective Inappropriate opioid prescribing after surgery contributes to opioid use disorder and risk of opioid overdose. In this cross-sectional analysis of orthopedic surgical patients, we examined the role of patient location on postoperative pain intensity and opioids prescribed on hospital discharge. Methods We used geospatial analyses to characterize spatial patterns of mean pain intensity on the day of discharge (PiDoD) and opioid units prescribed on the day of discharge (OuPoD), as well as the effect of regional social deprivation on these outcomes. Results At a 500-km radius from the surgery site, the Global Moran’s I for PiDoD (2.71 × 10−3, variance = 1.67 × 10−6, P = 0.012) and OuPoD (2.19 × 10−3, SD = 1.87, variance = 1.66 × 10−6, P = 0.03) suggested significant spatial autocorrelation within each outcome. Local indicators of spatial autocorrelation, including local Moran’s I, Local Indicator of Spatial Autocorrelation cluster maps, and Getis-Ord Gi* statistics, further demonstrated significant, specific regions of clustering both OuPoD and PiDoD. These spatial patterns were associated with spatial regions of area deprivation. Conclusions Our results suggest that the outcomes of pain intensity and opioid doses prescribed exhibit varying degrees of clustering of patient locations of residence, at both global and local levels. This indicates that a given patient’s pain intensity on discharge is related to the pain intensity of nearby individuals. Similar interpretations exist for OuPoD, although the relative locations of hot spots of opioids dispensed in a geographic area appear to differ from those of hot spots of pain intensity on discharge.

Funder

National Institutes of Health

NIH

Publisher

Oxford University Press (OUP)

Subject

Anesthesiology and Pain Medicine,Neurology (clinical),General Medicine

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