Kraekel Sean M, Cabarcas Brandon C, Salomon Kevin I, Gill Meera, Teytelbaum David, Miranda Michael A, Bernasek Thomas L
From the Florida Orthopaedic Institute, Tampa, FL (Kraekel, Cabarcas, Miranda, and. Bernasek) and the Foundation for Orthopaedic Research and Education, Tampa, FL (Salomon, Gill, and Teytelbaum).
J Am Acad Orthop Surg. 2023 Mar 1;31(5):258-264. doi: 10.5435/JAAOS-D-22-00651. Epub 2023 Jan 24.
Limited studies have assessed the impact of state regulations on opioid prescribing patterns for patients undergoing total knee arthroplasty (TKA). This study evaluates how Florida House Bill 21 (FL-HB21) affected postoperative opioid prescribing for patients after TKA.
Institutional review board approval was obtained to retrospectively review all patients who underwent TKA during 3 months of 2017 (pre-law) and 2018 (post-law) by five arthroplasty surgeons in Florida. Prescribed opioid quantity in morphine milligram equivalents (MME), quantity of refills, and number of prescribers were recorded for each patient's 90-day postsurgical episode. The differences between pre-law and post-law prescription data and short-term postoperative pain levels were compared.
The average total MME was notably reduced by over 30% for all time periods for the post-law group. The average MME per patient decreased by 169 MME at the time of discharge, by 245 MME during subsequent postoperative visits, and by 414 MME for the 90-day postsurgical episode ( P < 0.001 for all). The quantity of refills was unchanged (1.6 vs. 1.6, P = 0.885). The total number of prescribers per patient for the 90-day postsurgical episode was unchanged (1.31 vs. 1.24 prescribers/patient, P = 0.16). Postoperative pain levels were similar at discharge (3.6 pre-law vs. 3.3 post-law, P = 0.272).
Restrictive opioid legislation was associated with notably reduced postoperative opioid (MME) prescribed per patient after TKA at the time of discharge and for the entire 90-day postsurgical episode. There was no increase in the number of prescribers or refills required by patients.
Level III retrospective cohort.
仅有有限的研究评估了州法规对全膝关节置换术（TKA）患者阿片类药物处方模式的影响。本研究评估了佛罗里达州众议院法案21（FL-HB21）对TKA术后患者阿片类药物处方的影响。
获得机构审查委员会批准，对2017年（法律实施前）和2018年（法律实施后）3个月期间佛罗里达州5名关节置换外科医生实施TKA手术的所有患者进行回顾性研究。记录每位患者术后90天内开具的阿片类药物数量（以吗啡毫克当量[MME]计）、续方数量和开方医生数量。比较法律实施前后的处方数据差异以及术后短期疼痛水平。
法律实施后组在所有时间段内平均总MME显著降低超过30%。出院时每位患者的平均MME减少169 MME，术后随访期间减少245 MME，术后90天内减少414 MME（所有P<0.001）。续方数量未变（1.6比1.6，P=0.885）。每位患者术后90天内的开方医生总数未变（1.31名医生/患者比1.24名医生/患者，P=0.16）。出院时的术后疼痛水平相似（法律实施前为3.6，法律实施后为3.3，P=0.272）。
严格的阿片类药物立法与TKA术后出院时及整个术后90天内每位患者开具的阿片类药物（MME）显著减少相关。患者所需的开方医生数量或续方数量并未增加。
III级回顾性队列研究。
