Opioid Naive Surgeons and Opioid-Tolerant Patients: Can Education Alter Prescribing Patterns to Total Knee Arthroplasty Patients?

Abstract

Patterns of opioid overprescribing following arthroplasty likely developed given that poor pain control can diminish patient satisfaction, delay disposition, and lead to complications. Recently, interventions promoting responsible pain management have been described, however, most of the existing literature focuses on opioid naive patients. The aim of this study was to describe the effect of an educational intervention on opioid prescribing for opioid-tolerant patients undergoing primary total knee arthroplasty (TKA). As the start to a quality improvement initiative to reduce opioid overprescribing, a departmental grand rounds was conducted. Prescribing data, for the year before and after this intervention, were retrospectively collected for all opioid-tolerant patients undergoing primary TKA. Opioid prescribing data were standardized to mean morphine milligram equivalents (MME). Segmented time series regression was utilized to estimate the change in opioid prescribing associated with the intervention. A total of 508 opioid-tolerant patients underwent TKA at our institution during the study period. The intervention was associated with a statistically significant decrease of 468 mean MME (23%) from 2,062 to 1,594 (p = 0.005) in TKA patients. This study demonstrates that an educational intervention is associated with decreased opioid prescribing among opioid-tolerant TKA patients. While the effective management of these patients is challenging, surgeon education should be a key focus to optimizing their care.

A modern multimodal pain protocol eliminates the need for opioids for most patients following total knee arthroplasty: results from a retrospective comparative cohort study

“…Among the opioid‐naïve patients in this study, 73/356 (20%) used opioids postoperatively, which is very similar to the rate of 18% in the present study. Further, opioid use was very low among all 386 patients with 86.3% using 10 or fewer opioid pills through 3 months postoperatively [29]. Together, our findings and these data suggest that achieving opioid‐free or opioid‐minimal TKA may be possible in both opioid‐naïve and opioid‐experienced patients by expanding the window of multimodal pain management from the first 72 hours after surgery to 3 months after TKA and prescribing a low amount of opioids [28].…”

The Effect of an Electronic Prescribing Policy for Opioids on Physician Prescribing Patterns Following Common Upper Extremity Procedures

“…Physician and patient accountability are essential components in combating opioid overuse, as prior studies have shown that educational interventions focused on raising awareness of opioid overprescribing in both physicians and patients can lead to a significant decrease in postoperative opioid prescriptions and consumption. 6 , 7 , 8 , 9 , 23 , 24 , 25 Notably, the implementation of ePrescribing was an isolated change—prescribers prior to the implementation were required to perform background checks through a state prescription drug monitoring program and this database cross-reference continued. The advent of ePrescribing also did not have associated confounders—such as new limits in the number of opioids prescribed or mandatory training.…”