Implementation of a Patient-Specific Opioid Taper Calculator for Total Hip and Knee Arthroplasty: A Pre-Post Study

Roberto Alfonso Guzman; Jordan Ammons; Jerald Westberg; Andrew Schmidt

doi:10.1016/j.arth.2024.11.040

Implementation of a Patient-Specific Opioid Taper Calculator for Total Hip and Knee Arthroplasty: A Pre-Post Study

J Arthroplasty. 2024 Nov 29:S0883-5403(24)01253-1. doi: 10.1016/j.arth.2024.11.040. Online ahead of print.

Authors

Roberto Alfonso Guzman¹, Jordan Ammons², Jerald Westberg³, Andrew Schmidt⁴

Affiliations

¹ Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA; Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN, USA. Electronic address: guzma265@umn.edu.
² Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA.
³ Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN, USA.
⁴ Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA; Department of Orthopaedic Surgery, Hennepin County Medical Center, Minneapolis, MN, USA. Electronic address: Andrew.Schmidt@hcmed.org.

PMID: 39617272
DOI: 10.1016/j.arth.2024.11.040

Abstract

Background: Given the association between high opioid use and postoperative complications after total joint arthroplasty, it is important to prescribe opioids responsibly in the postoperative period. While many pain regimen protocols exist to try and limit opioid use, an optimal approach to narcotic prescription for arthroplasty patients is yet to be established. This study evaluated the effects of using an individualized opioid taper calculator for patients undergoing elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). We hypothesized that using the calculator would lead to a decrease in the amount and variability of opioids prescribed postoperatively.

Methods: All primary THAs (117 pre- and 105 post-calculator) and TKAs (172 pre- and 139 post-calculator) meeting study inclusion and exclusion criteria were reviewed at a single academic hospital from January 2016 to December 2018 (pre-calculator) and January 2020 to December 2022 (post-calculator). The primary outcome measure was the quantity of opioids prescribed at discharge in morphine milligram equivalents (MME) between the two groups. Secondary measures included opioid refills, visual analog scale (VAS) pain scores, and emergency department (ED) presentations or clinic calls due to pain. Statistical significance was defined as P < 0.05.

Results: Implementation of the opioid taper calculator resulted in a 40% decrease in the median MME prescribed at discharge for both THA (450 versus 270; P < 0.0001) and TKA (450 versus 270; P < 0.0001) patients, respectively. There was no significant difference within the THA or TKA cohorts when comparing VAS pain scores (THA, three versus four; P = 0.47; TKA; five versus six, P = 0.26), and no increase in percentage of patients who had ED visits (THA, 5.98 versus 0.95%; P = 0.069; TKA, 6.40 versus 11.5%; P = 0.155) or calls to the clinic for pain (THA, 17.1 versus 24.8%; P = 0.186; TKA, 36.6 versus 37.4%; P = 0.906) between the pre-calculator and post-calculator groups.

Conclusions: Our findings support the use of a patient-specific opioid taper calculator to decrease the volume and variability of narcotics prescribed postoperatively for THA and TKA pain management. Our findings confirmed the general applicability and effectiveness of the opioid taper calculator outside of its institution of origin.

Keywords: THA; TKA; complications; opioid epidemic.