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

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 precalculator and 105 postcalculator) and TKAs (172 precalculator and 139 postcalculator) meeting study inclusion and exclusion criteria were reviewed at a single academic hospital from January 2016 to December 2018 (precalculator) and January 2020 to December 2022 (postcalculator). The primary outcome measure was the quantity of opioids prescribed at discharge in morphine milligram equivalents between the two groups. Secondary measures included opioid refills, visual analog scale pain scores, and emergency department 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 morphine milligram equivalent 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 visual analog scale pain scores (THA, 3 versus 4; P = 0.47; TKA; 5 versus 6, P = 0.26), and no increase in percentage of patients who had emergency department 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 precalculator and postcalculator 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.