Florida Orthopaedic Institute, Temple Terrace, Florida.
Foundation for Orthopaedic Research and Education, Tampa, Florida; University of South Florida, Tampa, Florida.
J Arthroplasty. 2022 Sep;37(9):1771-1775. doi: 10.1016/j.arth.2022.04.007. Epub 2022 Apr 14.
To curtail the U.S. opioid crisis, many states have instituted regulations that mandate time and/or dosage limits for opioid prescriptions. This study evaluates the impact of one such law, Florida House Bill 21, on postoperative opioid prescribing patterns for patients undergoing total knee arthroplasty (TKA) and the durability of the law's impact over time.
All patients who underwent TKA at a single institution during the same three-month period in 2017 (pre-law), 2018 (post-law), and 2020 (2 years post-law) were identified. Outcomes and measures included: prescribed morphine milligram equivalents (MME) at discharge and for the 90-day surgical episode, refill quantity with associated MME, and quantity of opioid prescribers. Patients with established chronic pain or those who underwent contralateral TKA during the 90-day window were excluded. Data was compared using a one-way analysis of variance. Significance was set at alpha <0.05.
The average MME of filled opioid prescriptions per patient during the 90-day post-surgical episode decreased from 1310 MME in 2017 to 891 MME in 2018 (P < .001). The average MME in 2020 was 814 MME, which was significantly lower than the average in 2017 (P < .001), and statistically stable compared to the average in 2018 (P = .215).
Restrictive opioid state policy implementation was associated with reduced overall MME prescription to patients undergoing TKA at discharge and for the 90-day surgical episode. There was no increase in the number of opioid refills or opioid prescribers. Durable change and continued improvement were observed 2 years after implementation of law.
为了遏制美国阿片类药物危机，许多州都制定了法规，对阿片类药物处方的时间和/或剂量进行限制。本研究评估了其中一项法律，即佛罗里达州众议院第 21 号法案，对接受全膝关节置换术（TKA）的患者术后开具阿片类药物处方模式的影响，以及该法律的影响随时间的持久性。
在同一家机构，2017 年（法案实施前）、2018 年（法案实施后）和 2020 年（法案实施后 2 年）的同一三个月期间，所有接受 TKA 的患者均被确定为研究对象。结果和测量指标包括：出院时和 90 天手术期内开具的吗啡毫克当量（MME）、相关 MME 的续用量和阿片类药物开方者数量。排除有既定慢性疼痛或在 90 天窗口期内接受对侧 TKA 的患者。采用单向方差分析比较数据。显著性水平设定为 alpha <0.05。
在术后 90 天内，每位患者的阿片类药物处方 MME 从 2017 年的 1310 MME 减少到 2018 年的 891 MME（P <.001）。2020 年的平均 MME 为 814 MME，明显低于 2017 年的平均值（P <.001），与 2018 年的平均值相比统计学上是稳定的（P =.215）。
实施限制阿片类药物的州政策与接受 TKA 的患者出院时和 90 天手术期内开具的总体 MME 处方减少有关。阿片类药物的续用量或开方者数量没有增加。在该法律实施 2 年后，观察到了持久的变化和持续的改善。
