Shifts in Prescribers’ Initial Postoperative Opioid Prescriptions Following Primary Total Hip Arthroplasty Between 2014 and 2018

Goldman, Ashton H.; Griffis, Clare; Johnson, Daniel D.; Balazs, George C.

doi:10.1016/j.arth.2020.06.002

Cited by 7 publications

(10 citation statements)

References 19 publications

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Section: Methodsmentioning

confidence: 99%

“…We elected to separate tramadol from other immediate-release opioids because of its less-stringent DEA classification, the longstanding (but likely erroneous) belief that tramadol is safer than other opioids, and evidence that tramadol prescribing in the MHS is increasing. 9 Injectable products were excluded because these are typically physician-administered, and this study was focused on outpatient medications. Liquid, powder, and spray formulations were excluded from analysis because "quantity" for these prescriptions is typically recorded as units (bottles, packets, etc) and could not be converted to OMEs.…”

Section: Data Collectionmentioning

confidence: 99%

See 1 more Smart Citation

Opioid prescribing in the U.S. Military Health System, 2014 to 2018: fewer prescriptions, fewer pills, and shorter treatment duration

Goldman

Johnson²,

Griffis³

et al. 2021

Pain

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Prescription opioids remain an important driver of the opioid crisis in the United States. The purpose of this study was to examine recent changes in opioid prescribing patterns in the Military Health System (MHS) which is a nationwide health system service active duty military personnel and civilian beneficiaries. All patients prescribed opioid analgesics by MHS providers and filled at MHS pharmacies between 2014 and 2018 were identified. Prescriptions were converted to oral morphine equivalents (OMEs) and categorized based on prescribing specialty and formulation. Total opioid prescription counts and opioid prescription counts weighted by the annual number of outpatient encounters for each specialty were calculated, as were total OMEs and daily OMEs per prescription. A total of 3,427,308 prescriptions were included. Primary care providers and surgeons wrote 47% and 29% of opioid prescriptions, respectively. Over the study period, there was a 56% decline in annual opioid prescriptions, 25% decline in median total OMEs, and a 57% decline in opioid prescriptions per patient encounter. The proportion of prescriptions written for .90 OMEs per day declined 21%. Declines in opioid prescriptions and quantities were observed in nearly all specialties over the study period. The results of this study suggest a broad-based shift towards less opioid prescribing.

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Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Opioid prescribing in the U.S. Military Health System, 2014 to 2018: fewer prescriptions, fewer pills, and shorter treatment duration

Goldman

Johnson²,

Griffis³

et al. 2021

Pain

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“…Currently, there remains controversy regarding the perioperative use of TXA in THA, and few studies investigated the effect of TXA on postoperative hip pain in patients undergoing THA. Opioid abuse is currently a medical concern due to pain after total hip replacement [10]. In this study, we found that the topical use of TXA could reduce the in ammatory response in the early postoperative period, as shown by the lower CRP, IL-6 and ESR level in the early postoperative period, and the VAS score of the hip as well as the tramadol consumption were also signi cantly lower in the topical TXA group compared to the intravenous TXA group.…”

Section: Discussionmentioning

confidence: 60%

Topical use of tranexamic acid can reduce opioid consumption for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

Shen

Jiang

Wang

et al. 2023

Preprint

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Background: The problem of opioid addiction after total hip arthroplasty (THA) has been widely concerned. Tranexamic acid (TXA) has been shown to be effective in reducing blood loss for patients undergoing THA, but few studies focus on its alleviation of postoperative local pain symptoms. The purpose of this study was to investigate whether topical TXA could reduce early postoperative hip pain for primary THA patients, thereby reducing the use of opioids, and whether local pain is related to inflammatory response. Methods: In this prospective randomized controlled study, we randomly divided 161patients into a topical group (n=79) and an intravenous group (n=82). Hip pain was assessed using the visual analogue scale (VAS) score within three days after surgery and tramadol was used for pain relief when necessary. Inflammatory markers such as high-sensitivity C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), interleukin-6 (IL-6), total blood loss and hemoglobin drop were assessed by hematologic tests. The primary outcomes included the VAS score and dose of tramadol from the first to the third day after surgery. The secondary outcomes included the inflammatory markers level, total blood loss and complications. Results: The pain score and inflammation markers level on the first day in the topical TXA group were significantly lower than those in the intravenous TXA group (P＜0.05). The correlation analysis showed that the VAS score on the first day after surgery was positively correlated with the inflammation markers level (P＜0.05). The tramadol dose for topical group was lower than intravenous group on the first and second day after surgery. There were no differencesin total blood loss between the two groups (640.60± 188.12ml vs. 634.20± 187.85ml, P= 0.06). There was no difference in the incidence of complications. Conclusion: Topical use of TXA could relieve the local pain symptoms and reduce opioid consumption for patients undergoing primary THA by reduce the early postoperative inflammatory response. Trial registration: The trial was registered at the China Clinical Trial Registry (ChiCTR2100052396) on 10/24/2021.

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“… 13 Using a large claims database, Harris et al demonstrated a significant reduction in the number of patients receiving ≥90 MMEs after anterior cervical disectomy and fusion between 2010 and 2015 (1,811 [48%] versus 1,278 [43%]; P < 0.001). 11 Goldman et al 14 similarly reported a 27% decrease in oral MMEs when comparing patients undergoing primary total hip arthroplasty between 2014 and 2018. Our analysis further supports these findings by demonstrating statistically significant reductions in opioid prescriptions across a larger, national sample of orthopaedic surgeons.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple analyses have reported similar contemporary decreases in opioid prescriptions across orthopaedic subspecialties. 11 , 13 , 14 Flanagan et al 13 recently evaluated changes in opioid prescribing between 2012 and 2017 for orthopaedic trauma patients. After matching patients from each year by multiple variables, such as comorbidity burden and fracture location, the authors found significantly decreased total prescribed morphine milligram equivalents (MMEs) (1,110 versus 1,680 mg; P = 0.001) and refill amounts (766 versus 1,140 mg; P = 0.037) among the 2017 cohort compared with patients in 2012.…”

Section: Discussionmentioning

confidence: 99%

A Work in Progress: National Opioid Prescription Reductions Across Orthopaedic Subspecialties in a Contemporary Medicare Sample of 5,026,911 Claims

et al. 2021

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Introduction: As the opioid epidemic continues in the United States, efforts by orthopaedic surgeons to reduce opioid prescriptions remain critical. Although previous studies have demonstrated reductions in prescriptions across surgical specialties, there is limited information regarding contemporary trends in opioid prescriptions across orthopaedic subspecialties. Our analysis sought to estimate the frequency and trends of opioid prescriptions among Medicare Part D enrollees. Methods: The Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use Files from Centers of Medicare and Medicare from 2014 to 2018 were analyzed. These data were merged with the National Provider Identifier Registry to identify the subspecialty of providers. Prescriber opioid prescription rate, days per claim, and claims per patient were calculated. Temporal trends were tested using linear regression. Poisson regression was used to calculate annual adjusted incidence rate ratios while controlling for year, surgeon sex, average patient comorbidity risk score, and average patient age. Results: We analyzed 5,026,911 opioid claims prescribed to 2,661,762 beneficiaries. Among all orthopaedic surgeons, the opioid prescription rate per 100 beneficiaries significantly decreased over the study period from 52.99 (95% CI, 52.6 to 53.37) to 44.50 (44.06 to 44.93) ( P = 0.002). This decrease was observed for each subspecialty (all P values < 0.05). Similar significant reductions were appreciated across cohorts in the number of claims per beneficiary (all P values < 0.05). The opioid prescription rate among all orthopaedic surgeons and each subspecialty decreased significantly over the study period after controlling for various patient and surgeon characteristics (all P values < 0.05). Conclusion: Orthopaedic surgeons across subspecialties have reduced their rates of opioid prescriptions over recent years. Although increased prescription-limiting legislation, alternative methods of pain control, and prescriber reeducation regarding the correct quantity of opioids needed for postoperative pain relief, ongoing research, and efforts are needed to translate these reductions into clinically meaningful changes.

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Shifts in Prescribers’ Initial Postoperative Opioid Prescriptions Following Primary Total Hip Arthroplasty Between 2014 and 2018

Cited by 7 publications

References 19 publications

Opioid prescribing in the U.S. Military Health System, 2014 to 2018: fewer prescriptions, fewer pills, and shorter treatment duration

Opioid prescribing in the U.S. Military Health System, 2014 to 2018: fewer prescriptions, fewer pills, and shorter treatment duration

Topical use of tranexamic acid can reduce opioid consumption for patients undergoing primary total hip arthroplasty: a prospective randomized controlled trial

A Work in Progress: National Opioid Prescription Reductions Across Orthopaedic Subspecialties in a Contemporary Medicare Sample of 5,026,911 Claims

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