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Dawson Z, Stanton SS, Roy S, Farjo R, Aslesen HA, Hallstrom BR, Bicket MC. Opioid Consumption After Discharge From Total Knee and Hip Arthroplasty: A Systematic Review and Meta-Analysis. J Arthroplasty 2024; 39:2130-2136.e7. [PMID: 38336301 DOI: 10.1016/j.arth.2024.01.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Pain is challenging after recovery from total knee arthroplasty (TKA) and total hip arthroplasty (THA) procedures, and patients often receive prescription opioids. However, opioid consumption by patients remains unclear, and unused opioids may lead to risks including misuse and diversion. The objective of this systematic review and meta-analysis was to compare prescription size versus patient-reported consumption of opioids after discharge following TKA and THA. METHODS PubMed and Embase were systematically searched for publications published between 2015 and 2022 on patient-reported consumption of opioids after TKA and THA. The primary outcome was opioid use in oxycodone 5-mg equivalents. Team members independently reviewed studies for screening, inclusion, data extraction, and risk of bias. RESULTS Among the 17 included studies (15 TKA and 11 THA), discharge opioid prescribing exceeded consumption for both TKA (88.4 versus 65.0 pills at 6 weeks) and THA (64.0 versus 29.8 pills at 12 weeks). For both TKA and THA, the range of opioids prescribed varied significantly, by 1.6-fold for TKA and 2.8-fold for THA. Most studies reported pain outcomes (89%) and the use of nonopioid medications (72%). Of the 4 studies offering prescribing recommendations, the amounts ranged from 50 to 104 pills for TKA and 30 to 45 pills for THA. CONCLUSIONS Opioid prescribing exceeds the amount consumed following TKA and THA. These findings serve as a call to action to tailor prescribing guidelines to how much patients actually consume while emphasizing the use of nonopioid medications to better optimize recovery from surgery.
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Affiliation(s)
- Zahra Dawson
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - Sofea S Stanton
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - Samantha Roy
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - Reem Farjo
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - Heidi A Aslesen
- Department of Surgery, Michigan Medicine, Ann Arbor, Michigan; Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
| | - Brian R Hallstrom
- Department of Orthopaedic Surgery, Michigan Medicine, Ann Arbor, Michigan; Office of Clinical Affairs, Michigan Medicine, Ann Arbor, Michigan; Michigan Arthroplasty Registry Collaborative Quality Initiative, Ann Arbor, Michigan
| | - Mark C Bicket
- Michigan Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan; Department of Anesthesiology, Michigan Medicine, Ann Arbor, Michigan
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Christensen TH, Gemayel AC, Bieganowski T, Lawrence K, Rozell JC, Macaulay WB, Schwarzkopf R. Opioid Use during Hospitalization following Total Knee Arthroplasty: Trends in Consumption from 2016 to 2021. J Arthroplasty 2023; 38:S26-S31. [PMID: 37019314 DOI: 10.1016/j.arth.2023.03.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION In response to physician and patient concerns, many institutions have adopted protocols aimed at reducing postoperative opioid consumption after total knee arthroplasty (TKA). Thus, this study sought to examine how consumption of opioids has changed following TKA in the past six years. METHODS We conducted a retrospective review of all 10,072 patients who received primary TKA at our institution from January 2016 to April 2021. We collected baseline demographic data including patient age, sex, race, body mass index (BMI), American Society of Anesthesiologist (ASA) classification, as well as dosage and type of opioid medication prescribed on each postoperative day while the patient was hospitalized following TKA. This data was converted to milligram morphine equivalents (MME) per day hospitalized to compare rates of opioid use over time. RESULTS Our analysis found the greatest daily opioid use was in 2016 (43.2±68.6 MME/day) and the least was in 2021 (15.0±29.2 MME/day). Linear regression analyses found a significant linear downward trend in postoperative opioid consumption over time, with a decrease of 5.55 MME per day per year (Adjusted R-squared: 0.982, P<0.001). The highest visual analog scale (VAS) score was 4.45 in 2016 and the lowest was 3.79 in 2021 (P<0.001). CONCLUSION Opioid reducing protocols have been implemented for patients recovering from primary TKA in an effort to decrease reliance on opioids for postoperative pain control. The results of this study demonstrate that such protocols have been successful in reducing overall opioid use during hospitalization following TKA.
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Affiliation(s)
| | - Anthony C Gemayel
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Thomas Bieganowski
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Kyle Lawrence
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Joshua C Rozell
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - William B Macaulay
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
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Stephan A, Stadelmann VA, Preiss S, Impellizzeri FM. Measurement properties of PROMIS short forms for pain and function in patients receiving knee arthroplasty. J Patient Rep Outcomes 2023; 7:18. [PMID: 36854937 PMCID: PMC9975126 DOI: 10.1186/s41687-023-00559-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 02/10/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND While there are a few studies on measurement properties of PROMIS short forms for pain and function in patients with knee osteoarthritis, nothing is known about the measurement properties in patients with knee arthroplasty. Therefore, this study examined the measurement properties of the German Patient-Reported Outcomes Measurement Information System (PROMIS) short forms for pain intensity (PAIN), pain interference (PI) and physical function (PF) in knee arthroplasty patients. METHODS Short forms were collected from consecutive patients of our clinic's knee arthroplasty registry before and 12 months post-surgery. Oxford Knee Score (OKS) was the reference measure. A subsample completed the short forms twice to test reliability. Construct validity and responsiveness were assessed using scale-specific hypothesis testing. For reliability, Cronbach's alpha, intraclass correlation coefficients, and agreement using standard error of measurement (SEMagr) were used. Agreement was used to determine standardised effect sizes and smallest detectable changes (SDC90). Individual-level minimal important change (MIC) was calculated using a method of adjusted prediction. RESULTS Of 213 eligible patients, 155 received questionnaires, 143 returned baseline questionnaires and 119, 12-month questionnaires. Correlations of short forms with OKS were large (│r│ ≥ 0.7) with slightly lower values for PAIN, and specifically for men. Cronbach's alpha values were ≥ 0.84 and intraclass correlation coefficients ≥ 0.90. SEMagr were around 3.5 for PAIN and PI and 1.7 for PF. SDC90 were around 8 for PAIN and PI and 4 for PF. Follow-up showed a relevant ceiling effect for PF. Correlations with OKS change scores of around 0.5 to 0.6 were moderate. Adjusted MICs were 7.2 for PAIN, 3.5 for PI and 5.7 for PF. CONCLUSION Our results partly support the use of the investigated short forms for knee arthroplasty patients. The ability of PF to differentiate between patients with high perceived recovery is limited. Therefore, the advantages and disadvantages should be strongly considered within the context of the intended use.
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Affiliation(s)
- Anika Stephan
- Department of Teaching, Research and Development - Lower Extremities, Schulthess Clinic, Lengghalde 2, 8008, Zurich, Switzerland.
| | - Vincent A. Stadelmann
- grid.415372.60000 0004 0514 8127Department of Teaching, Research and Development – Lower Extremities, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland
| | - Stefan Preiss
- grid.415372.60000 0004 0514 8127Knee Surgery, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland
| | - Franco M. Impellizzeri
- grid.415372.60000 0004 0514 8127Department of Teaching, Research and Development – Lower Extremities, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland ,grid.117476.20000 0004 1936 7611Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007 Australia
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Barnes RH, Baumann CA, Woody N, Chen F, Creighton RA, Kamath GV, Spang JT. Prescribing Fewer Opioids After Rotator Cuff Repair and Anterior Cruciate Ligament Reconstruction Lowers Opioid Consumption Without Impacting Patient-Reported Pain Scores. Arthrosc Sports Med Rehabil 2022; 4:e1653-e1658. [PMID: 36312709 PMCID: PMC9596907 DOI: 10.1016/j.asmr.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 06/06/2022] [Accepted: 06/16/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To develop a standardized opioid prescribing schedule (SOPS) following anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR) and evaluate postoperative opioid consumption alongside Patient-Reported Outcome Measurement Information System (PROMIS) pain interference scores. Methods A prospective observational study was performed on all patients undergoing primary ACLR and RCR from March 2019 to October 2021. Patients taking opioids preoperatively and revision ACLR and RCR were excluded. PROMIS 6B questionnaires were administered before and after implantation of the SOPS initiated on December 15, 2019. Opioid consumption was determined by email surveys. Hypothesis testing was performed with Mann–Whitney U test. Results A total of 599 patients met inclusion criteria with 188 patients (71 ACLR and 117 RCR) completing surveys. Before the initiation of SOPS, the average number of oxycodone 5-mg tablets prescribed for ACLR was 44.6 (95% confidence interval [CI] 42.4-46.9) and for RCR was 44.7 (95% CI 42.7-46.8). The average usage was 23.1 (95% CI 16.9-29.2) and 22.1 (95% CI 16.2-28.0), respectively. Following SOPS of 30 tablets of oxycodone 5 mg for ACLR and 40 tablets for RCR, the average number of tablets prescribed significantly decreased for both procedures (P < .01 for ACLR and RCR), and the average consumption decreased to 20.5 (95% CI 16.6-24.4) and 18.6 (95% CI 14.6-22.5), respectively. PROMIS 6B responses did not demonstrate statistically significant changes following SOPS. Conclusions The results of the present study demonstrate that the implementation of a SOPS reduced postoperative opioid prescribing amounts and consumption without significant impacting PROMIS pain interference scores for ACLR and RCR, supporting the possibility to decrease and standardize opioid prescribing following common sports medicine procedures. Level of Evidence III: Retrospective, comparative, therapeutic study.
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Abstract
This paper is the forty-third consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2020 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
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Patel K, Stranges PM, Bobko A, Yan CH, Thambi M. Changes in postoperative inpatient and outpatient opioid utilization after pharmacist‐led order set standardization and education for total knee and hip replacement at an academic medical center. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kenil Patel
- Department of Pharmacy Practice University of Illinois at Chicago College of Pharmacy Chicago Illinois USA
| | - Paul M. Stranges
- Department of Pharmacy Practice University of Illinois at Chicago College of Pharmacy Chicago Illinois USA
| | - Aimee Bobko
- Department of Orthopaedics University of Illinois Hospital and Health Sciences System Chicago Illinois USA
| | - Connie H. Yan
- Department of Pharmacy Systems, Outcomes & Policy University of Illinois at Chicago College of Pharmacy Chicago Illinois USA
| | - Mathew Thambi
- Department of Pharmacy Practice University of Illinois at Chicago College of Pharmacy Chicago Illinois USA
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