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.
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.
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