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Institutional Guidelines Can Decrease the Amount of Opioids Prescribed After Total Joint Replacement.

Cynthia A Kahlenberg1, Jeffrey G Stepan1, Ajay Premkumar1

  • 1Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th Street, New York, NY 10021 USA.

HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery
|March 14, 2019
PubMed
Summary
This summary is machine-generated.

New guidelines for opioid prescribing after joint replacement surgery significantly reduced the number of pills prescribed. This initiative also led to fewer patient calls for opioid refills, demonstrating improved pain management and resource allocation.

Keywords:
arthroplastyopioidpain controlprescriptionstotal joint replacement

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Area of Science:

  • Orthopedic Surgery
  • Pain Management
  • Public Health

Background:

  • Addressing the opioid epidemic through improved prescriber education and guidelines for post-operative pain management in total joint arthroplasty.
  • Instituting a guideline recommending 70 opioid tablets for hip or knee replacement procedures.

Purpose of the Study:

  • To assess the effect of new institutional opioid prescribing guidelines on post-operative pain management practices.
  • To investigate the hypothesis that guidelines would decrease opioid prescription quantities while potentially increasing patient call volume.

Main Methods:

  • Retrospective review of opioid prescriptions for joint replacement patients from March 2016 to March 2018.
  • Analysis of post-operative telephone call volume to the nurse practitioner service before and after guideline implementation (February 2018).

Main Results:

  • Included 9514 patients in the analysis.
  • Mean prescribed opioid pills decreased from 91 ± 26.6 pre-guideline to 65 ± 16.3 post-guideline.
  • A statistically significant reduction in monthly unique patient telephone interactions was observed post-implementation.

Conclusions:

  • Institutional guidelines for opioid prescribing after total joint arthroplasty effectively reduced the quantity of prescribed opioid medications.
  • The implemented guidelines did not result in a significant increase in post-operative patient phone calls for opioid refills.