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Minimizing Opioids After Joint Operation: Protocol to Decrease Postoperative Opioid Use After Primary Total Knee

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Area of Science:

  • Orthopedic Surgery
  • Pain Management
  • Health Policy

Background:

  • Opioids are standard for post-arthroplasty pain but their use should be reduced.
  • The US Department of Veterans Affairs (VA) Portland implemented the Minimizing Opioids After Joint Operation (MOJO) protocol in 2018.
  • The MOJO protocol aimed to decrease opioid prescribing for total knee arthroplasty (TKA) patients.

Purpose of the Study:

  • To evaluate the effectiveness of the MOJO protocol in reducing opioid consumption after TKA.
  • To assess the impact of the MOJO protocol on patient pain control, length of stay, and healthcare utilization.

Main Methods:

  • A retrospective chart review compared 20 TKA patients using the MOJO protocol with 20 patients using the prior standard of care.
  • Outcomes measured included inpatient opioid use, emergency department visits, readmissions, pain scores, and length of stay.

Main Results:

  • The MOJO group showed significantly lower daily and total inpatient opioid use (morphine equivalent dose).
  • Patients in the MOJO group reported less pain on postoperative day 1 and had a shorter length of stay.
  • The MOJO protocol was associated with fewer emergency department visits and skilled nursing facility discharges.

Conclusions:

  • The MOJO protocol effectively reduced postoperative opioid use following TKA within the VA system.
  • The protocol achieved these reductions without negatively impacting pain management or increasing emergency department visits.
  • The MOJO protocol's framework may be adaptable for other institutions and surgical specialties seeking to minimize opioid use.