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Opioid Utilization After Primary Total Hip and Knee Arthroplasty Following Sequential Implementation of Statewide Legislation.

作者信息

Kakalecik Jaquelyn, Sipavicius Edvinas, Miley Emilie N, Horodyski MaryBeth, Gray Chancellor F, Prieto Hernan A, Parvataneni Hari K, Deen Justin T

机构信息

Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA.

College of Medicine, University of Florida, Gainesville, FL, USA.

出版信息

Arthroplast Today. 2023 Dec 29;25:101275. doi: 10.1016/j.artd.2023.101275. eCollection 2024 Feb.


DOI:10.1016/j.artd.2023.101275
PMID:38229868
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10790000/
Abstract

BACKGROUND: Following total hip arthroplasty (THA) and total knee arthroplasty (TKA), increased opioid use is associated with poor clinical outcomes. This study investigates implications of Florida legislative mandates on prescribing practices and opioid utilization following primary THA and TKA. METHODS: We retrospectively reviewed patients undergoing primary TKA or THA between January 1, 2018, to December 31, 2020 at our academic medical center. Three groups were identified: procedures performed prior to mandates, after seven-day prescription limit, and after mandated electronic prescribing. A multivariate analyses of variance evaluated length of stay, morphine milligram equivalents (MMEs), age, body mass index and number of prescription refills. Chi-square tests compared preoperative opioid use, readmissions, and discharge disposition. RESULTS: There were 198 patients in group one, 238 patients in group two, and 215 patients in group three (N = 651). Prior to any mandates, patients were prescribed 822.3 + 626.7 MMEs. Following a seven-day prescription limit this decreased to 465.0 + 296.0 MMEs ( < .001), which further decreased after mandated electronic prescribing (228.0 + 284.4 MMEs [ < 0.001]). Patients undergoing THA were prescribed less MME than those undergoing TKA. There was a 2.6% 90-day readmission rate, with no pain-related readmissions. CONCLUSIONS: Florida legislative mandates for opioid prescription quantities and electronic prescribing have effectively reduced average MMEs prescribed following primary arthroplasty. Despite a shift towards ambulatory surgery, opioid utilization decreased without compromising patient outcomes. These findings underscore the significance of both legislative and surgical practices influencing opioid prescribing habits among orthopaedic surgeons.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fc9f/10790000/d88b159c8dd9/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fc9f/10790000/5c8201074d32/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fc9f/10790000/d88b159c8dd9/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fc9f/10790000/5c8201074d32/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fc9f/10790000/d88b159c8dd9/gr2.jpg

相似文献

[1]
Opioid Utilization After Primary Total Hip and Knee Arthroplasty Following Sequential Implementation of Statewide Legislation.

Arthroplast Today. 2023-12-29

[2]
Changes in opioid discharge prescriptions after primary total hip and total knee arthroplasty affect opioid refill rates and morphine milligram equivalents : an institutional experience of 20,000 patients.

Bone Joint J. 2021-7

[3]
Larger Initial Opioid Prescriptions Following Total Joint Arthroplasty Are Associated with Greater Risk of Prolonged Use.

J Bone Joint Surg Am. 2021-1-20

[4]
The 2018 Chitranjan S. Ranawat, MD Award: Developing and Implementing a Novel Institutional Guideline Strategy Reduced Postoperative Opioid Prescribing After TKA and THA.

Clin Orthop Relat Res. 2019-1

[5]
Assessment of Postoperative Opioid Prescriptions Before and After Implementation of a Mandatory Prescription Drug Monitoring Program.

JAMA Health Forum. 2021-10

[6]
The Effect of Preoperative Tramadol Use on Postoperative Opioid Prescriptions After Primary Total Hip and Knee Arthroplasty: An Institutional Experience of 11,000 Patients.

J Arthroplasty. 2022-7

[7]
Opioid prescribing and utilization patterns in patients having elective hip and knee arthroplasty: association between prescription patterns and opioid consumption.

Can J Anaesth. 2022-8

[8]
Opioid Prescribing Habits of Orthopedic Surgeons Following Total Hip Arthroplasty and Total Knee Arthroplasty: A Pilot Study.

Can J Hosp Pharm. 2022-10-3

[9]
Mandatory Prescription Limits and Opioid Utilization Following Orthopaedic Surgery.

J Bone Joint Surg Am. 2019-5-15

[10]
Effects of a Prescription Drug Monitoring Program on Opioid Prescriptions Following Total Joint Arthroplasty in the State of California.

Orthopedics. 2023

本文引用的文献

[1]
National and State Level Opioid-Restricting Legislation in Total Joint Arthroplasty: A Systematic Review.

J Arthroplasty. 2022-1

[2]
Florida State Opioid Prescription Restriction Law: Impact on Opioid Utilization After Total Joint Arthroplasty.

J Arthroplasty. 2021-8

[3]
A Simple, Personalized Opioid Stratification Pathway Dramatically Reduces Opioid Utilization.

Arthroplast Today. 2020-8-27

[4]
Combating the Opioid Epidemic: Experience with a Single Prescription for Total Joint Arthroplasty.

Arthroplast Today. 2020-8-23

[5]
Reduction of Opioids Prescribed Upon Discharge After Total Knee Arthroplasty Significantly Reduces Consumption: A Prospective Study Comparing Two States.

J Arthroplasty. 2021-1

[6]
Revision Arthroplasty Does Not Require More Opioids Than Primaries: A Review of Prescribing Practices After Implementation of a Structured Perioperative Pain Management Strategy.

J Arthroplasty. 2020-8

[7]
Effects of the Ohio Opioid Prescribing Guidelines on Total Joint Arthroplasty Postsurgical Prescribing and Refilling Behavior of Surgeons and Patients.

J Arthroplasty. 2020-9

[8]
Opioid Prescribing Patterns in Orthopaedic Surgery Patients: the Effect of New York State Regulations and Institutional Initiatives.

J Am Acad Orthop Surg. 2020-12-15

[9]
Has a Prescription-limiting Law in Rhode Island Helped to Reduce Opioid Use After Total Joint Arthroplasty?

Clin Orthop Relat Res. 2020-2

[10]
Institutional Guidelines Can Decrease the Amount of Opioids Prescribed After Total Joint Replacement.

HSS J. 2019-2

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