Kakalecik Jaquelyn, Sipavicius Edvinas, Miley Emilie N, Horodyski MaryBeth, Gray Chancellor F, Prieto Hernan A, Parvataneni Hari K, Deen Justin T
Department of Orthopaedic Surgery & Sports Medicine, University of Florida, Gainesville, FL, USA.
College of Medicine, University of Florida, Gainesville, FL, USA.
Arthroplast Today. 2023 Dec 29;25:101275. doi: 10.1016/j.artd.2023.101275. eCollection 2024 Feb.
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.
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.
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.
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.
全髋关节置换术（THA）和全膝关节置换术（TKA）后，阿片类药物使用量增加与临床预后不良相关。本研究调查了佛罗里达州立法规定对初次THA和TKA术后处方行为及阿片类药物使用情况的影响。
我们回顾性分析了2018年1月1日至2020年12月31日在我们学术医疗中心接受初次TKA或THA的患者。确定了三组：在规定实施前进行的手术、在七天处方限制实施后进行的手术以及在强制电子处方实施后进行的手术。多因素方差分析评估了住院时间、吗啡毫克当量（MME）、年龄、体重指数和处方 refill次数。卡方检验比较了术前阿片类药物使用情况、再入院情况和出院处置情况。
第一组有198例患者，第二组有238例患者，第三组有215例患者（N = 651）。在任何规定实施前，患者被处方822.3 + 626.7 MME。在七天处方限制实施后，这一数字降至465.0 + 296.0 MME（<0.001），在强制电子处方实施后进一步降至228.0 + 284.4 MME（<0.001）。接受THA的患者被处方的MME比接受TKA的患者少。90天再入院率为2.6%，无疼痛相关再入院情况。
佛罗里达州关于阿片类药物处方量和电子处方的立法规定有效降低了初次关节置换术后处方的平均MME。尽管手术向门诊手术转变，但阿片类药物使用量减少且未影响患者预后。这些发现强调了立法和手术实践对骨科医生阿片类药物处方习惯的影响。
