How Successful Are Policies Aimed at Limiting Opioids Prescriptions After Arthroplasty?

The percentage of those receiving opioid prescriptions following a total hip arthroplasty (THA) or total knee arthroplasty (TKA) rose substantial from 2014 to 2017, with no clinically meaningful improvement in postoperative pain observed at discharge or up to 2 months during the time frame, according to a study in JAMA Network Open.

This cohort study used deidentified electronic health record data of patients from 38 hospital networks and 18 non-network hospitals across the United States. Specifically, patients were selected if they had undergone a THA (n=86,058) or TKA (n=150,573) at these hospitals between 2014 to 2017. The investigators analyzed whether patients had received any opioid prescription from discharge to 60 days following discharge. Pain levels at discharged as well as 2 months after discharge were also calculated.

The mean age of the overall cohort was 64.48 years. The proportion of patients prescribed an opioid within 60 days of discharge after a TKA increased from 81.9% in 2014 to 91.5% in 2017. Additionally, from 2014 to 2017, the proportion of patients who received an opioid prescription within 60 days of discharge after a THA was 82.0% to 89.7%. For both groups, the mean total morphine milligram equivalent prescribed within 60 days of discharge increased between the 2014 to 2015, but levels remained stable from 2015 to 2016 and decreased from 2016 to 2017.

Despite the increase in proportion of patients prescribed opioids from 2014 and 2017, the mean pain levels at discharged were similar across the years following THA and TKA.

Factors associated with higher odds of receiving ≥1 opioid prescription within a 60-day period of discharge among patients who underwent a THA included a more recent year of surgery (2015: adjusted odds ratio [aOR], 1.05; 95% CI, 1.04-1.06; 2016: aOR, 1.08; 95% CI, 1.07-1.08; 2017: aOR, 1.09; 95% CI, 1.08-1.10), higher pain score at discharge (1-3: aOR, 1.06; 95% CI, 1.04-1.07; 4-6: aOR, 1.07; 95% CI, 1.05-1.08; 7-10: aOR, 1.05; 95% CI, 1.03-1.07), insurance with Medicare only (aOR, 1.03; 95% CI, 1.03-1.04), and insurance with Medicaid only (aOR, 1.03; 95% CI, 1.01-1.04).

In contrast, variables associated with lower odds of opioid prescription were older age (55-64 years: aOR, 0.99; 95% CI, 0.98-0.99; 65-74 years: aOR, 0.96; 95% CI, 0.95-0.97; ≥75 years: aOR, 0.92; 95% CI, 0.91-0.93), and race/ethnicity (African American race: aOR, 0.97; 95% CI, 0.96-0.98; Hispanic ethnicity: aOR, 0.93; 95% CI, 0.91-0.95).

Limitations of the study included its retrospective design as well as the lack of information as to whether or not the patients actually took their prescribed opioid medications.

The investigators suggest that additional “research is needed on opioid prescribing patterns over time as new policies arise,” as this “research can inform development of effective approaches to reduce opioid overprescribing and improve postoperative pain control.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Shah R, Kuo YF, Westra J, Lin YL, Raji MA. Opioid use and pain control after total hip and knee arthroplasty in the US, 2014 to 2017. JAMA Netw Open. Published July 1, 2020. doi:10.1001/jamanetworkopen.2020.11972