Abstract
Patterns of opioid overprescribing following arthroplasty likely developed given that
poor pain control can diminish patient satisfaction, delay disposition, and lead to
complications. Recently, interventions promoting responsible pain management have
been described, however, most of the existing literature focuses on opioid naive patients.
The aim of this study was to describe the effect of an educational intervention on
opioid prescribing for opioid-tolerant patients undergoing primary total knee arthroplasty
(TKA). As the start to a quality improvement initiative to reduce opioid overprescribing,
a departmental grand rounds was conducted. Prescribing data, for the year before and
after this intervention, were retrospectively collected for all opioid-tolerant patients
undergoing primary TKA. Opioid prescribing data were standardized to mean morphine
milligram equivalents (MME). Segmented time series regression was utilized to estimate
the change in opioid prescribing associated with the intervention. A total of 508
opioid-tolerant patients underwent TKA at our institution during the study period.
The intervention was associated with a statistically significant decrease of 468 mean
MME (23%) from 2,062 to 1,594 (p = 0.005) in TKA patients. This study demonstrates that an educational intervention
is associated with decreased opioid prescribing among opioid-tolerant TKA patients.
While the effective management of these patients is challenging, surgeon education
should be a key focus to optimizing their care.
Keywords
arthroplasty - replacement - knee - pain - postoperative - opioid tolerant - quality
improvement - analgesics - opioid
