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A Multidisciplinary Patient-Specific Opioid Prescribing and Tapering Protocol Is Associated with a Decrease in Total

Mallika Tamboli1,2, Edward R Mariano1,2, Kerianne E Gustafson3

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Pain Medicine (Malden, Mass.)
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A new opioid discharge protocol for total hip arthroplasty (THA) significantly reduced morphine milligram equivalent (MME) doses by 63% within six weeks post-surgery. This protocol did not affect opioid refill rates, demonstrating effective opioid stewardship.

Keywords:
Acute Pain ServiceArthroplastyHip ReplacementOpioidPostoperative PainTapering

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Area of Science:

  • Orthopedic Surgery
  • Pain Management
  • Health Informatics

Background:

  • Opioid prescribing after total hip arthroplasty (THA) can lead to prolonged use.
  • Standardized discharge protocols are needed to optimize opioid management post-THA.
  • Multidisciplinary approaches can improve patient-specific care pathways.

Purpose of the Study:

  • To evaluate the impact of a multidisciplinary, patient-specific opioid discharge protocol on prescribed morphine milligram equivalent (MME) doses after THA.
  • To assess the effect of the protocol on opioid refills and other postoperative outcomes.

Main Methods:

  • Retrospective cohort study analyzing data from a Perioperative Surgical Home database and prescription records.
  • Comparison of opioid prescribing patterns (MME and refills) for THA patients before and after protocol implementation.
  • Patient-specific protocol based on 24-hour inpatient opioid consumption.

Main Results:

  • Total median MME prescribed for six weeks post-surgery decreased from 900 MME (PRE) to 295 MME (POST), a 67% reduction.
  • Median initial discharge prescription MME decreased from 675 MME (PRE) to 180 MME (POST).
  • Opioid refill rates and other secondary outcomes did not differ significantly between groups.

Conclusions:

  • Implementation of a patient-specific opioid prescribing and tapering protocol effectively reduces MME prescribed after THA.
  • The protocol achieved a 63% decrease in mean six-week opioid dosage without increasing refill rates.
  • This approach supports optimized opioid stewardship in orthopedic surgery.