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Standardized, Patient-specific, Postoperative Opioid Prescribing After Inpatient Orthopaedic Surgery

Chen, Eric Y. MD, PhD; Betancourt, Lauren MPH; Li, Lulu BS; Trucks, Emma MPH; Marcantonio, Andrew DO, MBA; Tornetta, Paul III MD

Journal of the American Academy of Orthopaedic Surgeons: July 26, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.5435/JAAOS-D-19-00030
Research Article: PDF Only
SDC

Background: Opioid-related mortality has increased over the past 2 decades, leading to the recognition of a nationwide opioid epidemic and prompting physicians to reexamine their opioid prescribing practices. At our institutions, we had no protocol for prescribing opioids upon discharge after inpatient orthopaedic surgery, resulting in inconsistent and potentially excessive prescribing. Here, we report the results of the implementation of a patient-specific protocol using an opioid taper calculator to standardize opioid prescribing at discharge after inpatient orthopaedic surgery.

Methods: The opioid taper calculator is a tool that creates a patient-specific opioid taper based on each patient's 24-hour predischarge opioid utilization. We implemented this taper for patients discharged after inpatient orthopaedic surgery at our two institutions (Boston Medical Center and Lahey Hospital and Medical Center—Burlington Campus). We compared discharge opioid quantities between orthopaedic patients postimplementation and quantities prescribed preimplementation. We also compared discharge opioid quantities between orthopaedic and nonorthopaedic surgical services over the same time period.

Results: Nine-months postimplementation, a patient-specific taper was used in 74% of eligible discharges, resulting in a 24% reduction in opioids prescribed at discharge, along with a 35% reduction in variance. Over the same time frame, a smaller reduction (9%) was seen in the opioids prescribed at discharge by nonorthopaedic services. The most notable reductions were seen after total joint arthroplasty and spinal fusions. Despite this reduction, most patients (65%) reported receiving sufficient opioids, and no substantial change was observed in 30-day postdischarge opioid prescription refills after versus before protocol implementation (1.58 versus 1.71 fills per discharge).

Discussion: Using the opioid taper calculator, a patient-specific taper can be successfully used to standardize opioid prescribing at discharge after inpatient orthopaedic surgery without a substantial risk of underprescription.

Level of Evidence: Level II

From the Department of Orthopaedic Surgery, Boston Medical Center (Dr. Chen and Dr. Tornetta), the Boston University School of Medicine (Ms. Betancourt, Ms. Li, Ms. Trucks, and Dr. Tornetta), Boston, MA, and the Department of Orthopaedic Surgery, Lahey Hospital and Medical Center, Burlington, MA (Dr. Marcantonio).

Correspondence to Dr. Chen: eric.chen@bmc.org

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Chen, Ms. Betancourt, Ms. Li, Ms. Trucks, Dr. Marcantonio, and Dr. Tornetta.

Ms. Betancourt and Ms. Li contributed equally to this work.

© 2019 by American Academy of Orthopaedic Surgeons
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