Revision Arthroplasty Does Not Require More Opioids Than Primaries: A Review of Prescribing Practices After Implementation of a Structured Perioperative Pain Management Strategy

• Published in: The Journal of arthroplasty 2020-08, Vol.35 (8), p.2173-2176
• Main Authors: Deen, Justin T., Stone, William Z., Gray, Chancellor F., Prieto, Hernan A., Iams, Dane A., Boezaart, Andre P., Parvataneni, Hari K.
• Format: Article
• Language: English
• Subjects: Analgesics, Opioid - therapeutic use; Arthroplasty, Replacement, Knee - adverse effects; Humans; opioid; Pain Management; Pain, Postoperative - drug therapy; prescription; primary; Retrospective Studies; revision total hip arthroplasty; revision total knee arthroplasty
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2020.04.003

There is a growing body of literature on opioid mitigation strategies following total joint arthroplasty. However, these have almost exclusively been studied in populations undergoing primary procedures, with revision arthroplasty historically thought to be more resistant due to procedural variability and complexity. We report on opioid utilization for revision arthroplasty following implementation of a structured, standardized opioid reduction strategy. Beginning January 2015, a comprehensive multidisciplinary pain protocol was developed and applied universally to all patients undergoing hip and knee arthroplasty, including revisions, without exclusion. We performed a retrospective review of opioid prescription trends for the revision arthroplasty subgroup between January 2014 and July 2018, with the first year serving as a baseline for comparison. Inpatient and outpatient opioid prescription data, inpatient satisfaction scores, and quality metrics were also reviewed. We identified 1273 revision arthroplasty cases in the study period. There was a significant reduction in average oral morphine equivalents utilized per procedure when comparing preintervention and postimplementation values. Overall, inpatient prescriptions decreased 24.1% and outpatient utilization decreased 62.4% over the study period. Significant reductions were seen in both the total hip (60.6%) and total knee (64.0%) subgroups. Although revision arthroplasty patients were prescribed 32.5% more oral morphine equivalents at baseline, at year 5 there was no significant difference in outpatient prescriptions between primary and revision subgroups. At our institution, a standardized opioid reduction strategy has resulted in marked reduction in opioid prescriptions for revision arthroplasty patients in line with generally successful reductions for primary arthroplasty. More importantly, with this approach, revision arthroplasty patients required no more outpatient opioids than their primary counterparts. Level III, Retrospective cohort study.