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

doi:10.1007/s12630-021-02145-5

. 2022 Aug;69(8):953-962.

doi: 10.1007/s12630-021-02145-5. Epub 2021 Dec 6.

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

Bokman Chan¹, Sarah Ward², Faraj W Abdallah³, Caroline Jones⁴, Angelo Papachristos⁴, Kyle Chin^{5

6}, Karim S Ladha^{5

7}, Gregory M T Hare^{5

7

6}

Affiliations

¹ Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. bokman.chan@unityhealth.to.
² Division of Orthopedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
³ Department of Anesthesiology and Pain Medicine, and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
⁴ Department of Physiotherapy, University of Toronto, Toronto, ON, Canada.
⁵ Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
⁶ Department of Physiology, University of Toronto, Toronto, ON, Canada.
⁷ Li Ka Shing Knowledge Institute, Toronto, ON, Canada.

PMID: 34873641
DOI: 10.1007/s12630-021-02145-5

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

Bokman Chan et al. Can J Anaesth. 2022 Aug.

. 2022 Aug;69(8):953-962.

doi: 10.1007/s12630-021-02145-5. Epub 2021 Dec 6.

Authors

Bokman Chan¹, Sarah Ward², Faraj W Abdallah³, Caroline Jones⁴, Angelo Papachristos⁴, Kyle Chin^{5

6}, Karim S Ladha^{5

7}, Gregory M T Hare^{5

7

6}

Affiliations

¹ Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. bokman.chan@unityhealth.to.
² Division of Orthopedic Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
³ Department of Anesthesiology and Pain Medicine, and The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
⁴ Department of Physiotherapy, University of Toronto, Toronto, ON, Canada.
⁵ Department of Anesthesia, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
⁶ Department of Physiology, University of Toronto, Toronto, ON, Canada.
⁷ Li Ka Shing Knowledge Institute, Toronto, ON, Canada.

PMID: 34873641
DOI: 10.1007/s12630-021-02145-5

Abstract
in English, French

Purpose: Although guidelines can reduce postoperative opioid prescription, the problem of unused opioids persists. We assessed the pattern of opioid prescription and utilization after total hip arthroplasty (THA) and total knee arthroplasty (TKA). We hypothesized that opioid prescription patterns can influence opioid utilization.

Methods: With institutional ethics approval, patients undergoing THA and TKA were enrolled prospectively. Surveys on opioid use were completed at two, six, and 12 weeks after surgery. Patients' age, sex, American Society of Anesthesiologists' Physical Status score, first 24-hr opioid consumption, quantity of opioid prescribed, and quantity of opioid utilized were analyzed to evaluate their effect on opioid consumption, unused opioid, and patient satisfaction.

Results: Patients received prescriptions ranging from 200 morphine milligram equivalents (MME) to 800 MME. Three hundred and thirty THA and 230 TKA patients completed the surveys. Opioid utilization was influenced by the amount of prescribed opioids for both THA and TKA. The percentage of prescribed opioids used (~55% in THA and ~75% in TKA) and the proportion of patients using all prescribed opioids (~22% in THA and ~50% in TKA) were higher after TKA vs THA (P < 0.001 for both). Patients who used opioids for two days or less accounted for most (~50%) of the unused opioid. Patient satisfaction remained high and was not influenced by the amount of prescribed opioid.

Conclusion: This study showed that larger prescriptions are associated with higher opioid consumption. A wide variation in opioid consumption requires approaches to minimize the initial opioid prescription and to provide additional prescriptions for patients that require higher levels of analgesia.

RéSUMé: OBJECTIF: Bien que les lignes directrices puissent réduire la prescription d’opioïdes postopératoires, le problème des opioïdes inutilisés persiste. Nous avons évalué les schémas de prescription et d’utilisation d’opioïdes après une arthroplastie totale de la hanche (ATH) et une arthroplastie totale du genou (ATG). Nous avons émis l’hypothèse que les schémas de prescription d’opioïdes pouvaient influencer l’utilisation des opioïdes. MéTHODE: Avec l’approbation du comité d’éthique de notre établissement, les patients bénéficiant d’une ATH et une ATG ont été recrutés de manière prospective. Les questionnaires sur la consommation d’opioïdes ont été complétés deux, six et 12 semaines après la chirurgie. L’âge, le sexe et le score de statut physique selon l’American Society of Anesthesiologists des patients, ainsi que la consommation d’opioïdes au cours des premières 24 heures postopératoires, la quantité d’opioïdes prescrits et la quantité d’opioïdes utilisés ont été analysés pour évaluer leur effet sur la consommation d’opioïdes, les opioïdes inutilisés et la satisfaction des patients. RéSULTATS: Les patients ont reçu des ordonnances allant de 200 équivalents de morphine en milligrammes (EMM) à 800 EMM. Trois cent trente patients bénéficiant d’une ATH et 230 patients d’une ATG ont répondu aux questionnaires. L’utilisation des opioïdes a été influencée par la quantité d’opioïdes prescrits pour l’ATH et l’ATG. Le pourcentage d’opioïdes prescrits utilisés (~55 % dans l’ATH et ~75 % dans l’ATG) et la proportion de patients utilisant tous les opioïdes prescrits (~22 % dans l’ATH et ~50 % dans l’ATG) étaient plus élevés après l’ATG vs l’ATH (P < 0,001 pour les deux). Les patients qui ont utilisé des opioïdes pendant deux jours ou moins étaient à l’origine de la plupart (~ 50%) des opioïdes inutilisés. La satisfaction des patients est demeurée élevée et n’a pas été influencée par la quantité d’opioïdes prescrits. CONCLUSION: Cette étude a démontré que les ordonnances plus élevées sont associées à une consommation plus élevée d’opioïdes. Une grande variation dans la consommation d’opioïdes nécessite des approches visant à minimiser la prescription initiale d’opioïdes et à fournir des ordonnances supplémentaires aux patients qui nécessitent des niveaux plus élevés d’analgésie.

Keywords: hip and knee surgery; opioid prescription; utilization.

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References

1. Shanthanna H, Ladha KS, Kehlet H, Joshi GP. Perioperative opioid administration. Anesthesiology 2021; 134: 645-59. - DOI
1. Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL. Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg 2017; 152: 1066-71. - DOI
1. Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in opioid prescribing through evidence-based prescribing guidelines. JAMA Surg 2018; 153: 285-7. - DOI
1. Brown CS, Vu JV, Howard RA, et al. Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system. BMJ Qual Saf 2021; 30: 251-9. - DOI
1. Roberts KC, Moser SE, Collins AC, et al. Prescribing and consumption of opioids after primary, unilateral total hip and knee arthroplasty in opioid-naive patients. J Arthroplasty 2020; 35: 960-5.e1. - DOI

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[1] Shanthanna H, Ladha KS, Kehlet H, Joshi GP. Perioperative opioid administration. Anesthesiology 2021; 134: 645-59. - DOI

[2] Shanthanna H, Ladha KS, Kehlet H, Joshi GP. Perioperative opioid administration. Anesthesiology 2021; 134: 645-59. - DOI

[3] Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL. Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg 2017; 152: 1066-71. - DOI

[4] Bicket MC, Long JJ, Pronovost PJ, Alexander GC, Wu CL. Prescription opioid analgesics commonly unused after surgery: a systematic review. JAMA Surg 2017; 152: 1066-71. - DOI

[5] Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in opioid prescribing through evidence-based prescribing guidelines. JAMA Surg 2018; 153: 285-7. - DOI

[6] Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in opioid prescribing through evidence-based prescribing guidelines. JAMA Surg 2018; 153: 285-7. - DOI

[7] Brown CS, Vu JV, Howard RA, et al. Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system. BMJ Qual Saf 2021; 30: 251-9. - DOI

[8] Brown CS, Vu JV, Howard RA, et al. Assessment of a quality improvement intervention to decrease opioid prescribing in a regional health system. BMJ Qual Saf 2021; 30: 251-9. - DOI

[9] Roberts KC, Moser SE, Collins AC, et al. Prescribing and consumption of opioids after primary, unilateral total hip and knee arthroplasty in opioid-naive patients. J Arthroplasty 2020; 35: 960-5.e1. - DOI

[10] Roberts KC, Moser SE, Collins AC, et al. Prescribing and consumption of opioids after primary, unilateral total hip and knee arthroplasty in opioid-naive patients. J Arthroplasty 2020; 35: 960-5.e1. - DOI

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

Affiliations

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

Authors

Affiliations

Abstract
in English, French

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Cited by

References

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LinkOut - more resources

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Medical

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Abstract in English, French

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Cited by

References

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Medical

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Abstract
in English, French