Reducing Opioid Prescriptions Lowers Consumption Without Detriment to Patient-Reported Pain Interference Scores After Total Hip and Knee Arthroplasties

Abstract

Background: Opioid addiction is endemic in the United States. We developed a standardized opioidprescribing schedule (SOPS) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) and evaluated opioid usage alongside Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference scores. We hypothesized that opioid usage would be less than prescribed and reducing prescription would decrease consumption without negatively impacting the PROMIS scores. Methods: A prospective observational study was performed on all patients undergoing primary THA and TKA from April 7, 2018, to August 10, 2019. Opioid consumption and pain interference were determined 2 weeks after discharge via telephone and email surveys. SOPSs were implemented during the study. Outcomes were compared in patients before and after the SOPS. Results: A total of 715 patients met inclusion criteria; 201 patients completed surveys. Before the SOPS, the mean opioid prescription was 81.2 ± 15.3 tablets for THA and 82.9 ± 10.6 for TKA. The mean usage was 35.1 ± 29.4 tablets and 35.4 ± 33.4, respectively. After the SOPS, the mean usage decreased to 19.4 ± 16.8 (P ¼ .04) and 31.6 ± 20.9 (P ¼ .52), respectively. After implementation of a second SOPS for THA, the mean number of tablets consumed was 21.5 ± 18.6 (P ¼ .05 compared with pre-SOPS). The PROMIS 6B responses in patients who underwent THA demonstrated no significant changes. PROMIS 6B responses for TKA showed an increase in interference with recreational activities (P ¼ .04) and tasks away from home (P ¼ .04), but otherwise had no significant impact on reported scores. Conclusions: Implementation of the SOPS reduced postoperative opioid prescription and consumption without significantly impacting the reported pain interference, supporting the need to decrease opioid prescription after THA and TKA.

Measurement properties of PROMIS short forms for pain and function in patients receiving knee arthroplasty

“…Pain and function are two relevant constructs for patients receiving knee arthroplasty. While there are a few studies on measurement properties of PROMIS short forms for pain and function in patients with knee osteoarthritis [ 7 – 9 ], nothing is known about the measurement properties in patients undergoing knee arthroplasty even though these tools are regarded as potentially useful for decision making [ 10 ] and have already been used for research in this patient group [ 11 , 12 ]. Two validation studies including osteoarthritis patients applied short forms of 6-item (pain interference) or 10-item (physical function) length [ 7 , 8 ], yet work examining the measurement properties of such or even shorter forms are still lacking.…”

Changes in postoperative inpatient and outpatient opioid utilization after pharmacist‐led order set standardization and education for total knee and hip replacement at an academic medical center

“…25 In a 715-patient prospective study, Barnes and colleagues implemented a standardized opioid prescribing schedule (SOPS) of 60 oxycodone 5 mg tablets for TKR/THR, which resulted in a 27% and 31% reduction in cumulative opioid pills prescribed at discharge for TKR and THR, respectively. 26 Furthermore, they implemented SOPS of 30 oxycodone 5 mg tablets for THR surgeries based on outpatient opioid consumption trends resulting in a total 58% reduction compared with previous practice. In contrast to these studies, we observed a more significant reduction in cumulative MED (55% vs 34%) and quantity of pills prescribed (22% vs 8%) for TKR procedures compared with THR, respectively.…”

Prescribing Fewer Opioids After Rotator Cuff Repair and Anterior Cruciate Ligament Reconstruction Lowers Opioid Consumption Without Impacting Patient-Reported Pain Scores

“…These results corroborate studies performed within the total hip and knee arthroplasty literature. 10 Although studies have demonstrated the impact of prescription-limiting legislation, including in knee and shoulder arthroscopy, previous literature has not evaluated PROMIS. 12 , 13 Previous literature has emphasized the importance of limiting postoperative opioid prescribing and the associated inferior patient outcomes following ACLR.…”

“… 9 The PROMIS 6B short form has been used in previous orthopaedic studies. 10 , 11 The PROMIS 6B short form is graded from 1 (not at all) to 5 (very much).…”