Opioids over-prescribed after total joint arthroplasty, finds study

Opioids are over-prescribed after total joint arthroplasty, Finds a new study appearing in Journal of Orthopaedics.

As the current opioid epidemic in the United States continues to escalate, greater emphasis has been placed on prescribers to moderate the use of opioids for pain management following surgical procedures. Orthopedic surgeons are the third highest group of prescribers of opioids, accounting for 11% of all high-volume specialties, yet standardized guidelines regulating opioid prescriptions for orthopedic patients are lacking.

The purpose of this study is to examine daily post-operative opioid frequency and quantity consumption for opioid-naïve patients undergoing total knee and hip arthroplasty (THA and TKA).

This study was an observational cohort study utilizing a patient journal for prospective data collection.

For every dose of pain medication (narcotic and non-narcotic) taken each day, patients were asked to provide the type and dosage of medication, the quantity consumed, the pain score at the time of consumption, the time of day used, and whether and for how long the medication provided relief. A separate log was provided for each day following discharge, up to 30 days postoperatively. Patients were instructed to complete a medication log each day until they ceased using opioids for pain control.

In order to standardize opioid data, dosages were converted to morphine equivalents (MEQ). The study reults were :

• TKA patients both were prescribed (p = 0.005) and reported consuming (p = 0.005) a higher MEQ than THA patients.

• Of the total MEQ consumed post-operatively, THA patients took 41% of the total during days 1–3 and 77% of the total during week 1 post-discharge, while TKA patients took 38% of the total during days 1–3 and 70% of the total during week 1 after discharge.

• Patients reporting consuming opioids for an average of 14.5 days post-discharge, with only 35% of patients reporting consumption beyond 2- weeks post-discharge.

• TKA patients reported taking opioids for a longer period after surgery compared to THA patients (p = 0.004) .

• Overall, pain scores at the time of opioid consumption averaged 4.3/ 10 for all patients, with TKA patients reporting higher levels of pain compared to THA patients (p = 0.032) .

• For TKA patients, pain scores at time of opioid consumption decreased from week 1 to week 2 post-discharge (p = 0.014). THA patients reported a continued decrease in pain scores from days 1–3 to week 1 post-discharge (p = 0.012) and from week 1 to week 2 post-discharge (p < 0.001).

• A higher proportion of opioids were consumed at night (52%) compared to during the day (48%). Approximately two-thirds of all opioids consumed by THA patients were taken at night, compared to only 43% of opioids for TKA patients (p = 0.012).The findings revealed that patients consume, on average, less than half of their prescribed opioids following TKA and THA procedures, with over 70% of the total opioids consumed during the first week following discharge.

The reduction in opioid consumption over the first two weeks post-operatively was associated with a reduction in reported pain scores.

In addition, pre-discharge factors that were found to predict higher post-operative opioid consumption included inpatient pain scores, inpatient MEQ consumption, and undergoing TKA procedures.

These data can be used to educate patients regarding pain expectations following surgery and develop evidence-based opioid tapering guidelines to effectively manage post-operative pain while limiting opioid use.

Further reading :Opioid over-prescription after total joint arthroplasty: Findings from patient reported opioid consumption journals.

Journal of Orthopaedics Volume 29, January–February 2022, Pages 1-5

https://doi.org/10.1016/j.jor.2021.12.001