The James A. Rand Young Investigator's Award: Large Opioid Prescriptions Are Unnecessary After Total Joint Arthroplasty: A Randomized Controlled Trial

Hannon, Charles P.; Calkins, Tyler E.; Li, Jefferson; Culvern, Chris; Darrith, Brian; Nam, Denis; Gerlinger, Tad L.; Buvanendran, Asokumar; Valle, Craig J. Della

doi:10.1016/j.arth.2019.01.065

Cited by 66 publications

(84 citation statements)

References 24 publications

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“…Effective postoperative pain control after TKA is important to reduce risk of complications, length of stay, and cost [18]. Multimodal analgesia has been an effective strategy to reduce opioid consumption; however, opioids are still a mainstay of postoperative Other surgeon category involves surgeons that had fewer than 100 cases in the study timeframe.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have investigated the differences in opioid consumption and prescription refills between TJA procedures, specifically comparing total hip arthroplasty vs TKA. Multiple studies have demonstrated that TKA patients maybe at higher risk for opioid refill and the downstream effects compared to total hip arthroplasty [18,32,36]. Recently, a study evaluated opioid use after primary hip and knee arthroplasty, utilizing self-reported patient consumption as the outcome of choice.…”

Section: Discussionmentioning

confidence: 99%

“…For both primary joint arthroplasty procedures, Hannon et al found that postdischarge pain score correlated positively with the number of pills consumed per day, averaging an extra 0.16 pills/d per a 1-point increase in a 10-point VAS scale. The Hannon et al [18] study identifies postoperative pain as a critical element to determining the postoperative pain management protocol following TJA. The impacts of mental and social health are understood to contribute to the variability in opioid consumption within the postoperative period.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Factors Associated with a Second Opioid Prescription Fill in Total Knee Arthroplasty

Wise

McCreary

Parikh

et al. 2020

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Factors Associated with a Second Opioid Prescription Fill in Total Knee Arthroplasty

Wise

McCreary

Parikh

et al. 2020

The Journal of Arthroplasty

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“…TKA patients, specifically, received an excess of 28%. A recent randomized trial of patients undergoing primary arthroplasty by Hannon et al 26 revealed that simply prescribing 30, instead of 90, 5 mg oxycodone immediate release tablets resulted in a significant reduction in opioid utilization without impacting pain or patient related outcome scores. Previous research has also demonstrated that on average for every additional opioid tablet prescribed after a surgical procedure an additional 1/2 tablet is consumed.…”

Section: Discussionmentioning

confidence: 99%

“…This is particularly worthwhile due to the fact that most current literature on the topic excludes any patients with any prior opioid exposure, regardless of the extent, from analysis. 12,26 Additionally, of the patients who received the majority of their care at our institution, only 10 were documented as having a single-narcotic prescription. Finally, while the data reveal statistically significant decreases in mean MME prescribed following a targeted intervention, other factors, such as an overall increasing awareness among physicians of excessive opioid prescribing may have also contributed to the decreased opioid prescribing trend observed.…”

Section: Limitationsmentioning

confidence: 99%

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

et al. 2020

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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.

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Changes in postoperative inpatient and outpatient opioid utilization after pharmacist‐led order set standardization and education for total knee and hip replacement at an academic medical center

Patel

Stranges

Bobko

et al. 2022

J Am Coll Clin Pharm

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Introduction: Opioid analgesics are often overprescribed after orthopedic procedures. Several strategies have been implemented nationally to curb opioid overprescription with modest success. At an institutional level, one novel idea is to implement surgery-specific guidelines limiting opioid quantities prescribed postoperatively.Objectives: The primary objective of this study was to evaluate the effect of our institution's new standardized postoperative multimodal pain regimen guidance on cumulative opioid prescribed postoperatively at discharge, as measured in morphine equivalent dose (MED). Methods: Adults (≥18 years old) who underwent total knee or total hip replacement from August 2019 through March 2020 were eligible. Patients not prescribed opioids at discharge, incarcerated, or had postoperative stays 7 or more days were excluded. A pharmacist-led standardized protocol was implemented on 21 November 2020, and provider education was completed on 18 December 2021. Patients were assigned to historical (August 2019 to November2019) or standardized (December 2019 to March 2020) cohorts based on discharge date. Secondary outcomes are cumulative and per-prescription opioid pills, morphine equivalent daily dose (MEDD) prescribed at discharge, inpatient opioid, diazepam, and gabapentin utilization, and outpatient post-op opioid and pain outcomes.Results: Forty patients preintervention and 52 patients postintervention were included. For postoperative discharge opioids prescribed, median cumulative MED decreased 46% (560.0 vs 300.0, P < .001), quantity of pills decreased 14.3% (70 vs 60, P = .03), and MEDD decreased 16.7% (60.0 vs 50.0, P < .001). Inpatient opioid exposure decreased 49% (38.1 vs 19.4, P < .001), concurrent diazepam (20.0% vs 1.9%, P = .009), and gabapentin (85.0% vs 13.5%, P < .001) use with opioids also decreased. Postoperative pain scores did not significantly differ (4.0 vs 5.0, P = .63). Conclusion:Pharmacist-led standardized protocol implementation resulted in reduced postoperative opioid prescription and exposure, and decreased concurrent

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The James A. Rand Young Investigator's Award: Large Opioid Prescriptions Are Unnecessary After Total Joint Arthroplasty: A Randomized Controlled Trial

Cited by 66 publications

References 24 publications

Factors Associated with a Second Opioid Prescription Fill in Total Knee Arthroplasty

Factors Associated with a Second Opioid Prescription Fill in Total Knee Arthroplasty

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

Changes in postoperative inpatient and outpatient opioid utilization after pharmacist‐led order set standardization and education for total knee and hip replacement at an academic medical center

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