Health Policy & EconomicsOpioid Prescribers to Total Joint Arthroplasty Patients Before and After Surgery: The Majority Are Not Orthopedists
Section snippets
Study Design and Setting
A cross-sectional study was conducted using data from a large integrated health-care system. This health-care system covers over 10.6 million lives in 7 geographical regions in the United States, including Southern California, Northern California, Hawaii, Northwest, Colorado, Mid-Atlantic, and Georgia [20]. The membership population of this health-care system has been shown to be largely socioeconomically and demographically representative of the largest geographical areas it covers [21], [22].
Results
In the year before surgery, the 31,699 TKA patients had 97,006 opioid prescriptions dispensed, while the 16,930 THA patients had 60,216. In the year after surgery, 172,158 opioid prescriptions were dispensed to the TKA cohort and 62,670 to the THA cohort. About 59.5% of TKA patients (median prescriptions dispensed/patient = 3, IQR 1-7) and 63.3% of THA patients (median prescriptions dispensed/patient = 3, IQR 1-8) had at least one opioid dispensed before surgery and 93.7% of TKA patients
Discussion
Conservative management of lower extremity arthritis includes the use of nonsteroidal anti-inflammatory drugs, activity modification, weight reduction, intra-articular injections, and the use of ambulatory assistive devices. The use of opioids have been seen for treatment of chronic osteoarthritis pain can be questioned because only small differences have not been seen between treatment with opioids and placebo [29]. The American Academy of Orthopedic Surgeons clinical guidelines committee
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2022, Journal of ArthroplastyCitation Excerpt :Specifically, in the year before TKA, orthopedic surgeons prescribed only 9% of the opioids, 47% in the 90 days after surgery and only 14% in the year that followed. Similarly, in the year before THA, orthopedic surgeons prescribed 14% of the opioids, 40% in the 90 days after surgery and only 14% in the year to follow [14]. Markel et al. demonstrated similar findings in a review of 367 patients undergoing TJA.
Preoperative Opioid Use Results in Greater Postoperative Opioid Consumption After Thumb Basal Joint Arthroplasty
2022, Journal of Hand Surgery Global OnlineCitation Excerpt :It also shows all prescriptions filled by the patient around the time of surgery, including those not prescribed by a surgeon. Namba et al25 reported that primary care and internal medicine providers were the highest opioid prescribers around the time of surgery in patients undergoing hip and knee replacement. In general, multiple studies have shown the highest number of opioid prescribers to be primary care providers, followed by pain medicine providers.26–28
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.05.034.
No external funding was obtained or used.