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Combating the Opioid Epidemic: Experience with a Single Prescription for Total Joint Arthroplasty.

ABSTRACT: Background:Despite advances in perioperative total joint arthroplasty (TJA) pain protocols, opiates continue to play a major role in postoperative pain control. This brief communication reports our experience with a restrictive opioid protocol allowing patients only a single prescription of low-dose opioids. Methods:One hundred consecutive elective, primary, and revision TJAs were analyzed. All patients received preoperative counseling and multimodal analgesia. Counseling involved discussion of patient expectations on postoperative pain management, weaning off opioids before surgery, and emphasis that opioid refills were not permitted. Ninety-day outcomes including pain-related phone calls, opioid refill requests, emergency room visits, complications, and readmissions were assessed. Opioid dispensing was tracked using our state prescription monitoring program. Results:There was a high prevalence of preoperative opioid use, depression, and anxiety (25%, 34%, and 39%, respectively). Sixty-eight percent of chronic opioid users were able to wean off opioids before surgery. The average initial prescription of opioids was equivalent to 48 pills of 5 mg oxycodone. There were only 10 pain-related phone calls from 9 patients; all were using opioids preoperatively, with only one patient requesting a refill. All pain-related phone calls occurred in the first week after surgery. There were no emergency room visits, complications, or readmissions related to pain. Conclusions:A single prescription of low-dose opioids was sufficient for patients undergoing TJA when using preoperative patient preparation and multimodal analgesia. Standardized guidelines are needed to guide best practices for patient education and pain management, especially in patients on chronic opioid therapy. This information will help implement evidence-based strategies to accelerate the decline of opioid use and hopefully pave the way for opioid-free TJA.

SUBMITTER: Sun D

PROVIDER: S-EPMC7451889 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Combating the Opioid Epidemic: Experience with a Single Prescription for Total Joint Arthroplasty.

Sun Daniel D Cusano Antonio A Harrington Melvin A MA Halawi Mohamad J MJ

Arthroplasty today 20200823 4

<h4>Background</h4>Despite advances in perioperative total joint arthroplasty (TJA) pain protocols, opiates continue to play a major role in postoperative pain control. This brief communication reports our experience with a restrictive opioid protocol allowing patients only a single prescription of low-dose opioids.<h4>Methods</h4>One hundred consecutive elective, primary, and revision TJAs were analyzed. All patients received preoperative counseling and multimodal analgesia. Counseling involved ...[more]

PMID: 32875017

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Project description:BackgroundObesity is a well-established risk factor for total joint arthroplasty (TJA) and a number of complications including prosthetic joint infection. The annual changes in the prevalence of obesity among primary, revision, and infected TJA has not been studied at a national level. Given the higher costs of complications of TJA, it is important to understand the association of obesity with the annual trends of revision and infected TJA.Questions/purposes(1) Is the prevalence of obesity increasing among patients undergoing THA/TKA? (2) Is the prevalence of obesity increasing among patients undergoing revision THA/TKA? (3) Is the prevalence of obesity increasing among patients with infected THA/TKA?MethodsAnnual volumes of primary, revision, and infected THA and TKA from 1998 to 2011 were obtained from the Nationwide Inpatient Sample. Using mathematical equations, the prevalence of obesity was estimated from relative risks and national obesity prevalence. National obesity prevalence was obtained from public health sources and the relative risk estimates were obtained from previously published meta-analyses and population-based studies. Annual prevalence of obesity was obtained by dividing the number of obese primary/revision/infected procedures in each year by the total number of corresponding procedures in that year. Annual changes in the prevalence of obesity were analyzed using linear regression.ResultsThe prevalence of obesity is increasing among patients undergoing THA (1998: 60,264 of 154,337 [39%], 2011: 160,241 of 305,755 [52%], increase of 1.05%/year [confidence interval {CI}, 0.95%-1.15%], p < 0.001) and TKA (1998: 143,681 of 251,309 [57%], 2011: 448,712 of 644,243 [70%], increase of 0.97%/year [CI, 0.87%-1.07%], p < 0.001). There was an increasing prevalence of obesity with THA revisions (1998: 16,322 of 34,139 [48%], 2011: 33,304 of 54,453 [61%], increase of 1.04%/year [CI, 0.94%-1.15%], p < 0.001) and in TKA revisions (1998: 16,837 of 26,539 [63%], 2011: 52,151 of 69,632 [75%], increase of 0.89%/year [CI, 0.79%-0.99%], p < 0.001). There was an increasing prevalence of obesity with THA infections (1998: 2068 of 3018 [69%], 2011: 6856 of 8687 [79%], increase of 0.80%/year [CI, 0.71%-0.89%], p < 0.001) and in TKA infections (1998: 3563 of 4684 [76%], 2011: 14,178 of 16,774 [85%], increase of 0.65%/year [CI, 0.57%-0.73%], p < 0.001).ConclusionsThe prevalence of obesity has increased in patients undergoing primary, revision, and infected TJA in United States. The obesity epidemic appears to be related to the growing trends of revision and infection after TJA. With the obesity rates expected to grow further, the revision and infection burden associated with obesity may increase in the future.Level of evidenceLevel II, prognostic study.

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Combating the Opioid Epidemic: Experience with a Single Prescription for Total Joint Arthroplasty.

Publications

Combating the Opioid Epidemic: Experience with a Single Prescription for Total Joint Arthroplasty.

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