Department of Orthopedic Surgery, NYU Langone Health, New York, New York.
Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
J Knee Surg. 2021 Sep;34(11):1196-1204. doi: 10.1055/s-0040-1702183. Epub 2020 Apr 20.
This study examined an early iteration of an inpatient opioid administration-reporting tool, which standardized patient opioid consumption as an average daily morphine milligram equivalence per surgical encounter (MME/day/encounter) among total knee arthroplasty (TKA) recipients. The objective was to assess the variability of inpatient opioid administration rates among surgeons after implementation of a multimodal opioid sparing pain protocol. We queried the electronic medical record at our institution for patients undergoing elective primary TKA between January 1, 2016 and June 30, 2018. Patient demographics, inpatient and surgical factors, and inpatient opioid administration were retrieved. Opioid consumption was converted into average MME for each postoperative day. These MME/day/encounter values were used to determine mean and variance of opioids prescribed by individual surgeons. A secondary analysis of regional inpatient opioid consumption was determined by patient zip codes. In total, 23 surgeons performed 4,038 primary TKA. The institutional average opioid dose was 46.24 ± 0.75 MME/day/encounter. Average intersurgeon (IS) opioid prescribing ranged from 17.67 to 59.15 MME/day/encounter. Intrasurgeon variability ranged between ± 1.01 and ± 7.51 MME/day/encounter. After adjusting for patient factors, the average institutional MME/day/encounter was 38.43 ± 0.42, with average IS variability ranging from 18.29 to 42.84 MME/day/encounter, and intrasurgeon variability ranging between ± 1.05 and ± 2.82 MME/day/encounter. Our results suggest that there is intrainstitutional variability in opioid administration following primary TKA even after controlling for potential patient risk factors. TKA candidates may benefit from the implementation of a more rigid standardization of multimodal pain management protocols that can control pain while minimizing the opioid burden. This is a level of evidence III, retrospective observational analysis.
这项研究考察了一种住院患者阿片类药物管理报告工具的早期迭代，该工具将全膝关节置换术 (TKA) 接受者每例手术的阿片类药物平均每日吗啡毫克当量 (MME/day/encounter) 标准化。目的是评估在实施多模式阿片类药物节约疼痛方案后，外科医生之间住院患者阿片类药物给药率的差异。我们在我院电子病历中查询了 2016 年 1 月 1 日至 2018 年 6 月 30 日期间接受择期初次 TKA 的患者。检索了患者人口统计学、住院和手术因素以及住院阿片类药物管理情况。将阿片类药物消耗换算成每个术后日的平均 MME。使用这些 MME/day/encounter 值来确定每位外科医生开的阿片类药物的平均值和方差。通过患者邮政编码确定了区域住院阿片类药物消费的二次分析。共有 23 名外科医生完成了 4038 例初次 TKA。机构平均阿片类药物剂量为 46.24±0.75 MME/day/encounter。外科医生之间的平均阿片类药物处方范围从 17.67 到 59.15 MME/day/encounter。外科医生内变异范围在±1.01 到±7.51 MME/day/encounter 之间。调整患者因素后，机构平均 MME/day/encounter 为 38.43±0.42，外科医生间变异范围从 18.29 到 42.84 MME/day/encounter，外科医生内变异范围在±1.05 到±2.82 MME/day/encounter 之间。我们的结果表明，即使控制潜在的患者风险因素，在初次 TKA 后，阿片类药物给药仍存在机构内变异。TKA 候选者可能受益于更严格的多模式疼痛管理方案的标准化实施，该方案可以在控制疼痛的同时最大限度地减少阿片类药物的负担。这是证据水平 III 的回顾性观察分析。
