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Institutional Guidelines Can Decrease the Amount of Opioids Prescribed After Total Joint Replacement

  • OPIOID PRESCRIBING AND PAIN MANAGEMENT / ORIGINAL ARTICLE
  • Published:
HSS Journal ®

Abstract

Background

In the midst of the nationwide opioid epidemic, our institution began an effort to improve the education of opioid prescribers and disseminate procedure-specific guidelines for the number of opioid pills to prescribe post-operatively for total joint arthroplasty. The number of opioid pills suggested for total hip or knee replacement was 70 tablets.

Questions/Purposes

We sought to evaluate the impact of the new institutional guideline on opioid prescribing practices, hypothesizing that it would lead to a decrease in the number of pills prescribed but an increase in patient call volume after discharge.

Methods

After the new guidelines were implemented in February 2018, we retrospectively reviewed all opioid prescriptions written for patients on the joint-replacement service from March 2016 to March 2018. In addition, we tabulated post-operative telephone calls made to the nurse practitioner service before and after guideline implementation. The majority of calls to the nurse practitioner service are for opioid renewals.

Results

We included 9514 patients in the analysis. Prior to guideline implementation, the mean number of pills prescribed after primary total joint arthroplasty was 91 ± 26.6 pills and after it was 65 ± 16.3 pills. The monthly number of unique patient telephone interactions was statistically significantly lower after the implementation of the new guidelines.

Conclusion

An institutional guideline for opioid prescribing after total joint arthroplasty significantly reduced the number of pills prescribed to patients without causing a significant increase in the number of phone calls to the service.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E. 70th Street, New York, NY, 10021, USA

    Cynthia A. Kahlenberg MD, Jeffrey G. Stepan MD, Ajay Premkumar MD, MPH, Francis D. Lovecchio MD & Michael B. Cross MD

Authors
  1. Cynthia A. Kahlenberg MD
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  2. Jeffrey G. Stepan MD
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  3. Ajay Premkumar MD, MPH
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  4. Francis D. Lovecchio MD
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  5. Michael B. Cross MD
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Corresponding author

Correspondence to Cynthia A. Kahlenberg MD.

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Conflict of Interest

Cynthia A. Kahlenberg, MD, Jeffrey G. Stepan, MD, Ajay Premkumar, MD, MPH, and Francis D. Lovecchio, MD, declare that they have no conflicts of interest. Michael B. Cross, MD, reports receiving grants or personal fees from or owning stock in Acelity, Exactech, Inc., Intellijoint, Link Orthopaedics, Smith & Nephew, Zimmer, Flexion Therapeutics, Imagen, Insight Medical, and Parvizi Surgical Innovation, as well as serving on the editorial or governing boards of Bone and Joint Journal 360, Journal of Orthopaedics and Traumatology, and Techniques in Orthopaedics, all outside the submitted work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was waived from all patients for being included in this study.

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Disclosure forms provided by the authors are available with the online version of this article.

Additional information

Level of Evidence: Level IV, retrospective review

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Kahlenberg, C.A., Stepan, J.G., Premkumar, A. et al. Institutional Guidelines Can Decrease the Amount of Opioids Prescribed After Total Joint Replacement. HSS Jrnl 15, 27–30 (2019). https://doi.org/10.1007/s11420-018-9632-6

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  • DOI: https://doi.org/10.1007/s11420-018-9632-6

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