Restrictive Opioid Prescribing Protocols Following Total Hip Arthroplasty and Total Knee Arthroplasty Are Safe and Effective

Holte, Andrew J.; Carender, Christopher N.; Noiseux, Nicolas; Otero, Jesse E.; Brown, Timothy S.

doi:10.1016/j.arth.2019.02.022

Cited by 35 publications

(24 citation statements)

References 27 publications

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“…Persistent pain after TKA can contribute to long-term opioid use, 62,63 which is a major public health crisis. 64,65 Comprehensive pain management programs (eg, opioid prescribing guidelines 66 ) and other behavioral interventions should be tested for this subgroup of patients in the postoperative period after TKA, with a goal to improve outcomes. Although the mean pain scores in the slow pain responder subgroup improved by 6 months, these patients did not reach the same status of the fast pain responder subgroup.…”

Section: Discussionmentioning

confidence: 99%

Association of Early Postoperative Pain Trajectories With Longer-term Pain Outcome After Primary Total Knee Arthroplasty

et al. 2019

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Section: Discussionmentioning

confidence: 99%

Association of Early Postoperative Pain Trajectories With Longer-term Pain Outcome After Primary Total Knee Arthroplasty

et al. 2019

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“…20 Holte et al retrospectively evaluated patient opioid consumption before and after implementation of a strict postoperative narcotic protocol in a total joint arthroplasty practice. 8 The authors found that patients treated prior to the restrictive opioid policy required more prescription refills and called into the office more frequently. Clinical outcomes were not significantly different between groups.…”

Section: Discussionmentioning

confidence: 99%

Patterns in Opioid Prescription for Patients Operatively Treated for Ankle Fractures Following Implementation of 2017 Ohio Opioid Prescriber Law

Glogovac

Fitts

Henning

et al. 2019

Foot & Ankle Orthopaedics

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Background: The purpose of this study was to report patterns of opioid prescription for patients treated operatively for ankle fractures after implementation of the 2017 Ohio Opioid Prescriber Law in comparison to the previous year. Methods: A total of 144 patients operatively treated for isolated ankle fractures during two 6-month periods, January 2017 to July 2017 (pre-law) and January 2018 to July 2018 (post-law), were retrospectively identified. Preoperative and postoperative patient narcotic use was reviewed using a legal prescriber database. Total number of prescriptions, quantity of pills, and morphine milligram equivalents (MMEs) per patient prescribed during the 90-day postoperative period were compared between those treated before and those treated after implementation of the Ohio prescriber law. Results: The average number of opioid prescriptions prescribed per patient in the 90-day postoperative period was 2.3 in the pre-law group and 2.1 in the post-law group ( P = .625). The average MMEs prescribed per patient dropped from 942.4 MME pre-law to 700.5 MME post-law ( P = .295). Differences in the average number of pills per prescription pre- and post-law (49.7 vs 36.2) and average MME per prescription (382.1 mg vs 275.2 mg) were statistically significant ( P < .001 and P = .016, respectively). Conclusion: Following the implementation of the 2017 Ohio Opioid Prescriber Law, there was a downward trend in the number of pills per prescription and MMEs per prescription in patients operatively treated for isolated ankle fractures. The presence of a downward trend in the quantity of opioids prescribed in this patient cohort suggests the effectiveness of the state law. Level of Evidence: Level III, comparative study.

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“…In the adult reconstruction realm, prior research has demonstrated that patients prescribed preoperative opioids are at higher risk for perioperative morbidity, revision, and less satisfactory outcomes [4][5][6][7][8][9][10][11]. Much attention has also been paid to postoperative opioid regimens, and there has been increasing recognition that conservative postoperative prescription patterns of opioids can be both safe and effective [12]. However, there has been a substantial increase in the number of patients being prescribed long-term opioids for chronic pain in the community (estimated at a 3-4% of those treated for chronic pain) [13,14].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty

Wilson

Farley

Aizpuru

et al. 2019

Advances in Orthopedics

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Introduction. Multiple studies have demonstrated that patients taking opioids in the preoperative period are at elevated risk for complications following total hip (THA) and knee (TKA) arthroplasty. However, the incidence and impact of opioid use disorder (OUD) among these patients—both clinically and fiscally—remain unknown. The purpose of this study was to investigate this relationship. Methods. The Nationwide Readmission Database (NRD) was used to identify patients undergoing THA and TKA from 2011 to 2015. Coarsened exact matching was used to statistically match the OUD and non-OUD cohorts. Further analysis was then conducted on matched cohorts with multivariate analysis. The incidence of OUD was also determined, and the costs associated with this comorbidity were calculated. Results. The incidence of OUD in arthroplasty patients increased 80% over the study period. OUD patients had higher odds of prosthetic joint infection (OR 1.55, 95% CI 1.23–1.94), wound complication (OR 1.40, 95% CI 1.12–1.76), prosthetic complication (OR 1.37, 95% CI 1.10–1.70), and revision surgery (OR 1.47, 95% CI 1.19–1.81). OUD patients also had longer length of stays (TKA: +0.67 days; THA: +1.09 days), higher readmission (OR 1.60, 95% CI 1.43–1.79), and increased 90-day costs (TKA: +$3,602 [95% CI $3,138–4,065]; THA: +4,527 [95% CI $3,593–4,920). Conclusion. Opioid use disorder is becoming a more common comorbidity among THA and TKA patients. This is concerning as it represents a significant risk factor for postoperative complication. It additionally confers increased perioperative costs. Patients with OUD should be counseled on their elevated risk, and future work will be needed to determine if this is a modifiable risk factor.

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Restrictive Opioid Prescribing Protocols Following Total Hip Arthroplasty and Total Knee Arthroplasty Are Safe and Effective

Cited by 35 publications

References 27 publications

Association of Early Postoperative Pain Trajectories With Longer-term Pain Outcome After Primary Total Knee Arthroplasty

Association of Early Postoperative Pain Trajectories With Longer-term Pain Outcome After Primary Total Knee Arthroplasty

Patterns in Opioid Prescription for Patients Operatively Treated for Ankle Fractures Following Implementation of 2017 Ohio Opioid Prescriber Law

The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty

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