Elsevier

The Journal of Arthroplasty

Volume 33, Issue 10, October 2018, Pages 3118-3124.e3
The Journal of Arthroplasty

Health Policy & Economics
Opioid Prescribers to Total Joint Arthroplasty Patients Before and After Surgery: The Majority Are Not Orthopedists

https://doi.org/10.1016/j.arth.2018.05.034Get rights and content

Abstract

Background

Improved narcotic pain management after total joint arthroplasty (TJA) is necessary to help battle the opioid epidemic. The goal of this study was to determine the sources of prescriptions prescribed to TJA patients.

Methods

An evaluation of opioid use in patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) was performed between 2008 and 2012. Using a Total Joint Replacement Registry and pharmacy data, opioids dispensed to TJA patients were identified. The main outcome of interest was who prescribed opioids to patients in the year before and after surgery.

Results

Primary care (pre-TKA 31% TKA, post-TKA 38%, pre-THA 34%, post-THA 40%) and internal medicine (27% pre-TKA, post-TKA 37%, pre-THA 32%, post-THA 40%) were the highest prescribers in the year before, and after, TJA. For TKA patients, orthopedists prescribed 9% of the opioids in the year before surgery, 47% in days 1-90 after surgery, and 14% in days 271-360. Similarly, in THA patients, orthopedists prescribed 14% of the opioids in the year before surgery, 40% in days 1-90 after surgery, and 14% in days 271-360.

Conclusion

Patients receive opioid prescriptions from multiple physician types before, and after, TJA. The majority of preoperative, and late postoperative, narcotics were not provided by their surgeons. Orthopedic surgeons may not even know that their TJA patients continue to receive opioids. Coordination of opioid care with health-care providers and greater communication with patients on narcotic use expectations should be promoted.

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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    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.

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