Effects of the Ohio Opioid Prescribing Guidelines on Total Joint Arthroplasty Postsurgical Prescribing and Refilling Behavior of Surgeons and Patients

Whale, Casey S.; Henningsen, Joseph; Huff, Scott; Schneider, Andrew; Hijji, Fady Y.; Froehle, Andrew W.

doi:10.1016/j.arth.2020.04.036

Cited by 12 publications

(12 citation statements)

References 13 publications

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“…The key characteristics of the 66 included studies [ 5 , 50 – 114 ] are detailed in Table 1 : Study Characteristics, Description of Strategies and Outcomes. Most studies used a retrospective cohort ( n = 35) [ 5 , 52 , 56 , 60 , 72 – 74 , 78 – 89 , 91 – 94 , 97 – 99 , 101 – 105 , 108 , 109 , 111 , 112 ], a randomized controlled trial (RCT) ( n = 24) [ 50 , 51 , 53 – 55 , 57 , 59 , 61 , 62 , 65 – 71 , 75 , 76 , 95 , 100 , 106 , 107 , 113 , 114 ] or a prospective cohort ( n = 7) [ 58 , 63 , 64 , 77 , 90 , 96 , 110 ] design. Almost all the studies were conducted in the U.S. ( n = 58) [ 5 , 50 – 57 , 59 – 61 , 63 , 67 – 74 , 77 – 99 , 101 – 114 ].…”

Section: Resultsmentioning

confidence: 99%

“…As described in Table 1 : Study Characteristics, Description of Strategies and Outcomes, selected studies were divided in seven categories, according to the type of strategy assessed. Among system-based strategies, we identified 22 studies on hospital-based protocols to limit or improve opioid prescriptions ( n = 13) [ 77 – 83 , 89 , 90 , 92 , 96 , 97 , 102 ] or formal government regulation in some U.S. states to limit opioid prescriptions ( n = 9) [ 85 – 88 , 91 , 93 , 103 – 105 ]. Among pharmacological strategies, we identified 18 studies [ 62 – 76 , 94 , 98 , 99 , 106 ], which mainly focused on the effect of anesthetic agents administered through regional anesthesia ( n = 8) [ 62 , 65 , 70 , 73 , 74 , 94 , 98 , 99 ] and the impact of medication on the central nervous system [ 63 , 66 , 67 , 69 ] ( n = 4) and opioid use.…”

Section: Resultsmentioning

confidence: 99%

“…None of the studies measured illicit opioid use or opioid diversion (i.e., opioid diverted from siblings who have legitimate prescriptions). Data came from patient records or clinical-administrative databases ( n = 27) [ 5 , 60 , 73 , 74 , 78 – 81 , 83 – 89 , 91 , 94 , 98 , 101 – 105 , 108 , 110 , 112 , 114 ], or a combination of these methods, and from patient self-report ( n = 17) [ 53 , 55 , 58 , 62 , 63 , 65 , 68 , 71 , 72 , 77 , 82 , 90 , 96 , 100 , 107 , 109 , 113 ] in many studies. The remaining studies measured outcomes from self-reported data only ( n = 5) [ 50 , 54 , 67 , 69 , 95 ] or did not clearly describe the data source ( n = 17) [ 51 , 52 , 56 , 57 , 59 , 61 , 64 , 66 , 70 , 75 , 76 , 92 , 93 , 97 , 99 , 106 , 111 ].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Côté

Bérubé

Moore

et al. 2022

BMC Musculoskelet Disord

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Background Long-term opioid use, which may have significant individual and societal impacts, has been documented in up to 20% of patients after trauma or orthopaedic surgery. The objectives of this scoping review were to systematically map the research on strategies aiming to prevent chronic opioid use in these populations and to identify knowledge gaps in this area. Methods This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched seven databases and websites of relevant organizations. Selected studies and guidelines were published between January 2008 and September 2021. Preventive strategies were categorized as: system-based, pharmacological, educational, multimodal, and others. We summarized findings using measures of central tendency and frequency along with p-values. We also reported the level of evidence and the strength of recommendations presented in clinical guidelines. Results A total of 391 studies met the inclusion criteria after initial screening from which 66 studies and 20 guidelines were selected. Studies mainly focused on orthopaedic surgery (62,1%), trauma (30.3%) and spine surgery (7.6%). Among system-based strategies, hospital-based individualized opioid tapering protocols, and regulation initiatives limiting the prescription of opioids were associated with statistically significant decreases in morphine equivalent doses (MEDs) at 1 to 3 months following trauma and orthopaedic surgery. Among pharmacological strategies, only the use of non-steroidal anti-inflammatory drugs and beta blockers led to a significant reduction in MEDs up to 12 months after orthopaedic surgery. Most studies on educational strategies, multimodal strategies and psychological strategies were associated with significant reductions in MEDs beyond 1 month. The majority of recommendations from clinical practice guidelines were of low level of evidence. Conclusions This scoping review advances knowledge on existing strategies to prevent long-term opioid use in trauma and orthopaedic surgery patients. We observed that system-based, educational, multimodal and psychological strategies are the most promising. Future research should focus on determining which strategies should be implemented particularly in trauma patients at high risk for long-term use, testing those that can promote a judicious prescription of opioids while preventing an illicit use, and evaluating their effects on relevant patient-reported and social outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Côté

Bérubé

Moore

et al. 2022

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…The Virginia legislation, in contrast with that of Rhode Island, does not differentiate between opioid-naïve and opioid-tolerant patients. Similarly, Whale et al showed that Ohio opioid-limiting legislation decreased the morphine equivalent doses among patients undergoing THA and TKA [ 10 ]. They demonstrated that a large portion of this decrease is attributed to a reduction in the amount of opioids prescribed at discharge, which is the time period assessed in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…Although these studies address changes in prescribing after the implementation of opioid prescribing guidelines, they are only at the institution and departmental level. Both Whale et al and Reid et all showed that state-level legislation was effective in reducing MME in the immediate postoperative period after primary THA and TKA in 2 different states [ 10 , 11 ]. Similarly, Lott et al showed that state-level legislation led to a reduction in discharge opioid prescribing after orthopaedic surgery procedures [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of State Legislation on Discharge Opioid Prescriptions After Total Hip and Knee Arthroplasties

et al. 2020

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Background Recent literature suggests that state-level legislation is effective in reducing postoperative opioid prescribing after total joint arthroplasty but has not addressed the effect on opioid antagonist coprescribing. This study aims to describe the change in postoperative opioid and opioid antagonist prescribing patterns after total joint arthroplasty following passage of state-level opioid-limiting legislation and to determine the comorbidities associated with increased opioid prescribing in this population. Methods Billing data were used to identify all patients who underwent primary total hip or knee arthroplasty admitted between March 2016 and March 2018 at our institution. The data were divided into 2 cohorts comprising the year before (671 subjects) and after (713 subjects) the legislation. Discharge prescriptions were reviewed, and the median morphine milligram equivalents (MME) per day and naloxone prescriptions were recorded. International Classification of Diseases codes were used to identify comorbid conditions of interest present during previous inpatient or outpatient encounters. Results There was a significant reduction in both the minimum and maximum median MME per day after introduction of state legislation and a substantial increase in opioid antagonist coprescription. Total knee arthroplasty, younger age, male sex, chronic pain disorders, post-traumatic stress disorder, and prior opioid abuse were correlated with increased opioid prescribing. Conclusion Our findings suggest that state-level legislation is effective in decreasing the MME per day prescribed and increasing opioid antagonist coprescription in the postoperative period for patients undergoing total hip and knee arthroplasties at our institution. These changes may lead to a decrease in opioid-related morbidity and mortality in the patient population undergoing total hip and knee arthroplasties.

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Post-total joint arthroplasty opioid prescribing practices vary widely and are not associated with opioid refill: an observational cohort study

Highland

Sowa

Herrera

et al. 2023

Arch Orthop Trauma Surg

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Effects of the Ohio Opioid Prescribing Guidelines on Total Joint Arthroplasty Postsurgical Prescribing and Refilling Behavior of Surgeons and Patients

Cited by 12 publications

References 13 publications

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

Effect of State Legislation on Discharge Opioid Prescriptions After Total Hip and Knee Arthroplasties

Post-total joint arthroplasty opioid prescribing practices vary widely and are not associated with opioid refill: an observational cohort study

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