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J Knee Surg 2021; 34(10): 1042-1047
DOI: 10.1055/s-0040-1701449
Original Article

Opioid Naive Surgeons and Opioid-Tolerant Patients: Can Education Alter Prescribing Patterns to Total Knee Arthroplasty Patients?

Connor A. King 
1   Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
,
David C. Landy
1   Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
,
Alexander T. Bradley
1   Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
,
Bryan Scott
1   Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
,
John Curran
2   Pritzker School of Medicine, University of Chicago, Chicago, Illinois
,
Shwetha Devanagondi
3   Medicine Analytics Core, University of Chicago, Chicago, Illinois
,
Tessa Balach
1   Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
,
Megan Conti Mica
1   Department of Orthopaedic Surgery, University of Chicago, Chicago, Illinois
› Author Affiliations Funding None.
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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

Supplementary Material



Publication History

Received: 29 May 2019

Accepted: 13 December 2019

Article published online:
04 March 2020

© 2020. Thieme. All rights reserved.

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