Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA.
Biostatistics Core, Research Administration, Hospital for Special Surgery, New York, New York, USA.
Bone Joint J. 2021 Jul;103-B(7 Supple B):103-110. doi: 10.1302/0301-620X.103B7.BJJ-2020-2392.R1.
AIMS: Due to the opioid epidemic in the USA, our service progressively decreased the number of opioid tablets prescribed at discharge after primary hip (THA) and knee (TKA) arthroplasty. The goal of this study was to analyze the effect on total morphine milligram equivalents (MMEs) prescribed and post-discharge opioid repeat prescriptions. METHODS: We retrospectively reviewed 19,428 patients undergoing a primary THA or TKA between 1 February 2016 and 31 December 2019. Two reductions in the number of opioid tablets prescribed at discharge were implemented over this time; as such, we analyzed three periods (P1, P2, and P3) with different routine discharge MME (750, 520, and 320 MMEs, respectively). We investigated 90-day refill rates, refill MMEs, and whether discharge MMEs were associated with represcribing in a multivariate model. RESULTS: A discharge prescription of < 400 MMEs was not a risk factor for opioid represcribing in the entire population (p = 0.772) or in opioid-naïve patients alone (p = 0.272). Procedure type was the most significant risk factor for narcotic represcribing, with unilateral TKA (hazard ratio (HR) = 5.62), bilateral TKA (HR = 6.32), and bilateral unicompartmental knee arthroplasty (UKA) (HR = 5.29) (all p < 0.001) being the highest risk for refills. For these three procedures, there was approximately a 5% to 6% increase in refills from P1 to P3 (p < 0.001); however, there was no significant increase in refill rates after any hip arthroplasty procedures. Total MMEs prescribed were significantly reduced from P1 to P3 (p < 0.001), leading to the equivalent of nearly 500,000 fewer oxycodone 5 mg tablets prescribed. CONCLUSION: Decreasing opioids prescribed at discharge led to a statistically significant reduction in total MMEs prescribed. While the represcribing rate did not increase for any hip arthroplasty procedure, the overall refill rates increased by about 5% for most knee arthroplasty procedures. As such, we are now probably prescribing an appropriate amount of opioids at discharge for knee arthroplasty procedure, but further reductions may be possible for hip arthroplasty procedures. Cite this article: 2021;103-B(7 Supple B):103-110.
目的：由于美国阿片类药物泛滥，我们的服务在髋（THA）和膝关节（TKA）初次置换后逐渐减少了出院时开具的阿片类药物片剂数量。本研究的目的是分析规定的总吗啡毫克当量（MME）数量和出院后阿片类药物重复处方的影响。
方法：我们回顾性分析了 2016 年 2 月 1 日至 2019 年 12 月 31 日期间接受初次 THA 或 TKA 的 19428 例患者。在此期间，我们实施了两次减少出院时开具的阿片类药物片剂数量的措施；因此，我们分析了三个时期（P1、P2 和 P3），常规出院 MME 分别为 750、520 和 320 MME。我们在多变量模型中研究了 90 天的再填充率、再填充 MME 和出院 MME 是否与重新处方有关。
结果：出院时开具的<400MME 处方并不是全人群（p=0.772）或阿片类药物初治患者（p=0.272）重新开阿片类药物处方的危险因素。手术类型是阿片类药物再处方的最重要危险因素，单侧 TKA（危险比（HR）=5.62）、双侧 TKA（HR=6.32）和双侧单髁膝关节置换术（UKA）（HR=5.29）（均 p<0.001）是再填充的最高风险因素。对于这三种手术，从 P1 到 P3，再填充率增加了约 5%至 6%（p<0.001）；然而，任何髋关节置换手术后，再填充率都没有显著增加。从 P1 到 P3，规定的总 MME 显著减少（p<0.001），导致大约减少了近 500,000 片羟考酮 5mg 片剂的处方。
结论：减少出院时开具的阿片类药物导致规定的总 MME 数量显著减少。虽然任何髋关节置换手术的再处方率都没有增加，但大多数膝关节置换手术的总体再填充率增加了约 5%。因此，我们现在可能为膝关节置换手术开出了适当数量的阿片类药物，但髋关节置换手术可能还可以进一步减少。
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