Reducing Opioid Prescriptions Lowers Consumption Without Detriment to Patient-Reported Pain Interference Scores After Total Hip and Knee Arthroplasties

Ryan H. Barnes, MD; Joshua A. Shapiro, MD; Nathan Woody, CSSBB; Fei Chen, PhD; Christopher W. Olcott, MD; Daniel J. Del Gaizo, MD

Arthroplasty Today (Dec 2020)

Reducing Opioid Prescriptions Lowers Consumption Without Detriment to Patient-Reported Pain Interference Scores After Total Hip and Knee Arthroplasties

Ryan H. Barnes, MD,
Joshua A. Shapiro, MD,
Nathan Woody, CSSBB,
Fei Chen, PhD,
Christopher W. Olcott, MD,
Daniel J. Del Gaizo, MD

Affiliations

Ryan H. Barnes, MD: Department of Orthopaedics, University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC, USA; Corresponding author. Department of Orthopaedics, University of North Carolina at Chapel Hill Hospital, 130 Mason Farm Road #3147, Chapel Hill, NC 27599-7010, USA. Tel.: +1 919 966 9166.
Joshua A. Shapiro, MD: Department of Orthopaedics, University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC, USA
Nathan Woody, CSSBB: Department of Anesthesiology, University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC, USA
Fei Chen, PhD: Department of Anesthesiology, University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC, USA
Christopher W. Olcott, MD: Department of Orthopaedics, University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC, USA
Daniel J. Del Gaizo, MD: Department of Orthopaedics, University of North Carolina at Chapel Hill Hospital, Chapel Hill, NC, USA

Journal volume & issue: Vol. 6, no. 4
pp. 919 – 924

Abstract

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Background: Opioid addiction is endemic in the United States. We developed a standardized opioid-prescribing schedule (SOPS) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and evaluated opioid usage alongside Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference scores. We hypothesized that opioid usage would be less than prescribed and reducing prescription would decrease consumption without negatively impacting the PROMIS scores. Methods: A prospective observational study was performed on all patients undergoing primary THA and TKA from April 7, 2018, to August 10, 2019. Opioid consumption and pain interference were determined 2 weeks after discharge via telephone and email surveys. SOPSs were implemented during the study. Outcomes were compared in patients before and after the SOPS. Results: A total of 715 patients met inclusion criteria; 201 patients completed surveys. Before the SOPS, the mean opioid prescription was 81.2 ± 15.3 tablets for THA and 82.9 ± 10.6 for TKA. The mean usage was 35.1 ± 29.4 tablets and 35.4 ± 33.4, respectively. After the SOPS, the mean usage decreased to 19.4 ± 16.8 (P = .04) and 31.6 ± 20.9 (P = .52), respectively. After implementation of a second SOPS for THA, the mean number of tablets consumed was 21.5 ± 18.6 (P = .05 compared with pre-SOPS). The PROMIS 6B responses in patients who underwent THA demonstrated no significant changes. PROMIS 6B responses for TKA showed an increase in interference with recreational activities (P = .04) and tasks away from home (P = .04), but otherwise had no significant impact on reported scores. Conclusions: Implementation of the SOPS reduced postoperative opioid prescription and consumption without significantly impacting the reported pain interference, supporting the need to decrease opioid prescription after THA and TKA.

Published in Arthroplasty Today

ISSN: 2352-3441 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Surgery: Orthopedic surgery
Website: https://www.journals.elsevier.com/arthroplasty-today/

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