The Impact of State Level Public Policy, Prescriber Education, and Patient Factors on Opioid Prescribing in Elective Orthopedic Surgery: Findings From a Tertiary, Academic Setting

Abstract

Background: The United States is in the midst of an opioid misuse epidemic. There have been recent changes to North Carolina's public policy leading to institutional education attempting to reduce high-risk opioid prescribing. This study investigated whether state-level and institutional efforts were associated with provider-level changes in opioid prescriptions after common orthopedic surgeries.

Patients and methods: Six-week post-operative opioid prescribing in patients 18 years or older undergoing high-volume elective surgeries were reviewed retrospectively. Three patient cohorts from equivalent calendar year periods were included in this analysis; preceding policy implementation (January 1, 2017, to March 31, 2017), immediately after policy implementation (January 1, 2018, to March 31, 2018), and 1 year after policy implementation (January 1, 2019, to March 31, 2019). Multivariable models were constructed to evaluate the effects of public policy and institutional education on postoperative opioid prescribing.

Results: The mean (standard deviation) amount of oxycodone 5-mg equivalents prescribed at discharge decreased from 75.6 (53.2) in 2017 to 55.7 (36.2) in 2018 and then 45.6 (32.6) in 2019 (P < .05). Similarly, 6-week postoperative cumulative oxycodone 5-mg equivalents prescribed also significantly decreased from 123.3 (145.8) in 2017 to 84.1 (90.3) in 2018 and to 80.2 (150.1) in 2019. Other outcomes including prescription duration and rates of outlier prescribing showed similar trends.

Conclusion: In a North Carolina tertiary academic hospital, opioid prescribing decreased after public policy implementation and an institutional response of education for prescribers within a national context of changing practices in opioid prescribing. State-level public policy and prescriber education could be important avenues for decreasing postoperative opioid prescription in orthopedic settings.

Keywords: ACDF, anterior cervical discectomy and fusion; ACLR, anterior cruciate ligament reconstruction; CDC, Centers for Disease Control; CSRS, Controlled Substances Reporting System; CTR, carpal tunnel release; NSAID, nonsteroidal anti-inflammatory drug; RCR, rotator cuff repair; STOP, Strengthen Opioid Misuse and Prevention; STROBE, Strengthen the Reporting of Observational Studies in Epidemiology; TAA, total ankle arthroplasty; THA, total hip arthroplasty; TKA, total knee arthroplasty.