1
|
Bahoravitch T, Roberts M, Zhao A, Stake S, Ernst B, Thakkar SC. Trends From 2010 to 2019 in Opioid and Nonopioid Pain Management After Total Knee Arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202406000-00006. [PMID: 38866713 PMCID: PMC11175854 DOI: 10.5435/jaaosglobal-d-23-00062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 03/04/2024] [Accepted: 03/11/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION As the opioid epidemic enters its third decade, we reflect on how it has affected clinical practice within the orthopaedic community. Recent studies show prolonged opioid use after total knee arthroplasty (TKA) is associated with worse overall health outcomes. This study aims to elucidate trends in pain management after TKA over the past decade. METHODS A retrospective analysis was performed using the PearlDiver database from 2010 to 2019. Patients who underwent primary TKA without a history of mental illness, complex pain syndromes, or opioids used 6 months before surgery were selected. Postoperative prescription filling rates of opioid and nonopioid at 30, 90 days, and 1 year from surgery were analyzed. Linear regression analysis and compound annual growth rates (CAGRs) were analyzed from 2010 to 2019, a P value <0.05 being considered significant. RESULTS Between 2010 and 2019, 579,269 patients underwent primary TKA. At 30 days, filling of prescriptions for opioids (CAGR = 3.54%) and nonopioids (CAGR = 15.50%) markedly increased from 2010 to 2019. At 90 days, opioids decreased (CAGR = -4.42%). At 1 year, opioid (CAGR = -10.92%) and nonopioid (CAGR = -2.12%) prescriptions markedly decreased from 2010 to 2019. DISCUSSION This study highlights patterns of decreased opioid prescription rates at 90 days and 1 year postoperatively from 2010 to 2019. Decreasing opioid rates may indicate effectiveness in targeted public health campaigns to curb opioid overuse.
Collapse
Affiliation(s)
- Tyler Bahoravitch
- From the Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC (Dr. Bahoravitch, Ms. Zhao, and Dr. Stake); the Department of Biochemistry, Georgetown University Medical Center, Washington, DC (Dr. Roberts); the Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA (Dr. Ernst); and the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Thakkar)
| | - Max Roberts
- From the Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC (Dr. Bahoravitch, Ms. Zhao, and Dr. Stake); the Department of Biochemistry, Georgetown University Medical Center, Washington, DC (Dr. Roberts); the Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA (Dr. Ernst); and the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Thakkar)
| | - Amy Zhao
- From the Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC (Dr. Bahoravitch, Ms. Zhao, and Dr. Stake); the Department of Biochemistry, Georgetown University Medical Center, Washington, DC (Dr. Roberts); the Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA (Dr. Ernst); and the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Thakkar)
| | - Seth Stake
- From the Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC (Dr. Bahoravitch, Ms. Zhao, and Dr. Stake); the Department of Biochemistry, Georgetown University Medical Center, Washington, DC (Dr. Roberts); the Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA (Dr. Ernst); and the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Thakkar)
| | - Brady Ernst
- From the Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC (Dr. Bahoravitch, Ms. Zhao, and Dr. Stake); the Department of Biochemistry, Georgetown University Medical Center, Washington, DC (Dr. Roberts); the Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA (Dr. Ernst); and the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Thakkar)
| | - Savyasachi C. Thakkar
- From the Department of Orthopaedic Surgery, George Washington University School of Medicine and Health Sciences, Washington, DC (Dr. Bahoravitch, Ms. Zhao, and Dr. Stake); the Department of Biochemistry, Georgetown University Medical Center, Washington, DC (Dr. Roberts); the Department of Orthopaedic Surgery, Virginia Commonwealth University School of Medicine, Richmond, VA (Dr. Ernst); and the Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Dr. Thakkar)
| |
Collapse
|
2
|
Jarusriwanna A, Pornrattanamaneewong C, Narkbunnam R, Ruangsomboon P, Thitithapana P, Chareancholvanich K. Does the accelerometer-based navigation system reduce blood loss and transfusion in one-stage sequential bilateral total knee arthroplasty? A randomized double-blind controlled trial. BMC Musculoskelet Disord 2023; 24:531. [PMID: 37386413 DOI: 10.1186/s12891-023-06648-8] [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: 02/12/2023] [Accepted: 06/16/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Total knee arthroplasty (TKA) is associated with significant blood loss and postoperative transfusion. The accelerometer-based navigation (ABN) system guides the bone cutting plane without breaching the intramedullary canal, which may reduce bleeding. This study aimed to investigate blood loss and transfusion compared between the ABN system and the conventional procedure in patients undergoing one-stage sequential bilateral TKA (SBTKA). METHODS A total of 66 patients scheduled for SBTKA were randomly allocated to either the ABN or conventional group. Postoperative hematocrit (Hct) level, drainage blood loss, transfusion rate, and amount of packed red cell transfusion were collected. Total red blood cell (RBC) loss was then calculated for the primary outcome. RESULTS The mean calculated total RBC loss in the ABN and conventional group was 669.7 and 630.0 mL, respectively (p = 0.572). There was no significant difference between groups for other evaluated outcome parameters, including postoperative Hct level, drainage blood loss, or packed red cell transfusion volume. All patients in the conventional group required postoperative blood transfusion while 96.8% of patients in the ABN group were transfused. CONCLUSIONS The total RBC loss and volume of packed red cells transfusion were not significant difference between interventions, which suggest no benefit of the ABN system in reducing blood loss and transfusion in patients undergoing SBTKA. TRIAL REGISTRATION The protocol of this study was registered in the Thai Clinical Trials Registry database no. TCTR20201126002 on 26/11/2020.
Collapse
Affiliation(s)
- Atthakorn Jarusriwanna
- Department of Orthopaedics, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | | | - Rapeepat Narkbunnam
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pakpoom Ruangsomboon
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Keerati Chareancholvanich
- Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
3
|
Berardino K, Carroll AH, Ricotti R, Popovsky D, Civilette MD, Urits I, Viswanath O, Sherman WF, Kaye AD. The Ramifications of Opioid Utilization and Outcomes of Alternative Pain Control Strategies for Total Knee Arthroplasties. Orthop Rev (Pavia) 2022; 14:37496. [PMID: 36045694 DOI: 10.52965/001c.37496] [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] [Indexed: 11/06/2022] Open
Abstract
Morbidity and mortality related to opioid use has generated a public health crisis in the United States. Total knee arthroplasty (TKA) is an increasingly common procedure and is often accompanied by post-operative opioid utilization. Unfortunately, post-operative opioid usage after TKA has been shown to lead to higher rates of complications, longer hospital stays, increased costs, and more frequent need for revision surgery. Pre-operative opioid utilization has been shown to be one of the most important predictors of post-operative opioid usage. Additional risk factors for continued post-operative opioid utilization after TKA include pre-operative substance and tobacco use as well as higher post-operative prescription dosages, younger age, female gender, and Medicaid insurance. One method for mitigating excessive post-operative opioid utilization are Enhanced Recovery After Surgery (ERAS) protocols, which include a multidisciplinary approach that focuses on perioperative factors to optimize patient recovery and function after surgery. Additional strategies include multimodal pain regimens with epidural anesthetics, extended duration local anesthetics and adjuvants, and ultrasound guided peripheral nerve blocks. In recent years, opioid prescribing duration limitations have also been put into place by state and federal government, hospital systems, and ambulatory surgery centers making effective acute pain management imperative for all stakeholders. In this regard, as rates of TKA continue to increase across the United States, multidisciplinary efforts by all stakeholders are needed to ensure adequate pain control while preventing the negative sequalae of opioid medications.
Collapse
Affiliation(s)
| | | | | | | | | | - Ivan Urits
- Department of Anesthesiology, Louisiana State University Health Science Center Shreveport
| | - Omar Viswanath
- Innovative Pain and Wellness; Department of Anesthesiology, Creighton University School of Medicine
| | | | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Science Center Shreveport
| |
Collapse
|