Journal of the American Academy of Orthopaedic Surgeons最新文献

{"title":"Low-Molecular-Weight Heparin Combined With Somatosensory Evoked Potential Monitoring for Prevention of Postoperative Lower Extremity Deep Vein Thrombosis in Patients With Spinal Fracture.","authors":"Junjun Liao, Guangliang Lu, Zhihua Wang","doi":"10.5435/JAAOS-D-24-01437","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01437","url":null,"abstract":"<p><strong>Background: </strong>To assess the effect of low-molecular-weight heparin (LMWH) combined with evoked potentials somatosensory evoked potential (SEP) on the prevention of deep vein thrombosis (DVT) in patients undergoing spinal surgery.</p><p><strong>Methods: </strong>One hundred twenty-eight patients who underwent spinal surgery from August 2022 to August 2023 were chosen, and the patients were randomly classified into the control group and the observation group, with 64 cases in each group. The control group received LMWH injections.The observation group received SEP monitoring on the basis of the control group. The blood flow velocity of popliteal veins of both lower limbs was measured by Color Doppler ultrasonography. The D-dimer concentration was measured using intravenous blood samples taken 1 day before surgery, after surgery, and 24 hours after surgery. The incidence of lower extremity DVT was diagnosed by ultrasonography during surgery and 24 hours after surgery.</p><p><strong>Results: </strong>Compared with the control group, the blood flow velocity of the popliteal veins in both lower limbs in the observation group increased at T2-4 (P < 0.001), and the D-dimer and FIB concentrations in the observation group were decreased (P < 0.001); the occurrence of DVT in the observation group was lower than that in the control group (P < 0.05).</p><p><strong>Conclusion: </strong>LMWH combined with SEP monitoring can effectively prevent the occurrence of lower limb DVT in patients with spinal surgery.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735734","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Writing a Letter of Recommendation Without Bias.","authors":"Brian Feeley, Katherine Bach, Andrew Gatto, Nesa Milan","doi":"10.5435/JAAOS-D-24-00827","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00827","url":null,"abstract":"<p><p>Letters of recommendation (LORs) play a pivotal role in the highly competitive orthopaedic surgery residency and fellowship applications, with increasing influence amid evolving evaluation metrics. LORs are crucial in providing nuanced insights into applicants' clinical competencies, personal qualities, and potential fit within programs, complementing standardized test scores and academic achievements. However, despite their importance, LORs are susceptible to implicit biases, particularly affecting women and underrepresented minorities. Research underscores disparities in language use, with gender and racial stereotypes influencing adjectival choices and narrative emphasis. Strategies to mitigate bias include adopting a consistent outline, emphasizing agentic and standout adjectives over communal and grindstone traits, and using precise language and specific examples. We advocate for LORs that are detailed, specific, equitable, and avoid stereotypes, aiming to support fair evaluation practices and promote diversity within orthopaedics. By examining current biases and proposing best practices, this review contributes to ongoing efforts to enhance equity in the residency and fellowship selection process.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The New Centers for Medicare and Medicaid Services Patient-Reported Outcome-Based Performance Measure: What It Means and How Can I Align.","authors":"Lauren M Shapiro, Kevin J Bozic, Mark McClellan, Kurt Spindler","doi":"10.5435/JAAOS-D-24-01000","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01000","url":null,"abstract":"<p><p>The recognition of the benefits of the measurement and utilization of patient-reported outcome measures (PROMs) in clinical care continues to increase. Furthermore, the Centers for Medicare and Medicaid Services recently mandated a patient-reported outcome-based performance measure (PRO-PM) supporting the measurement of PROMs pre- and postoperatively for patients undergoing primary hip and knee arthroplasty. Under this new policy, hospitals not measuring and reporting complete data on 50% or more of included patients are at risk for substantial loss of Medicare Part A reimbursement. As with any new policy, there are nuances, barriers, possible undesirable consequences, and opportunities for improvement that should be considered and mitigated for said policy to have the greatest potential benefit on the population. In this article, we review the implications of the new policy, barriers to successful implementation, and possible undesirable consequences, and aim to provide guidance and strategies to assist surgeons, health systems, and other stakeholders in understanding, aligning with, and improving care based on the new Centers for Medicare and Medicaid Services PROM-PM.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the Linking Between the Orthopaedic In-Training Examination and the American Board of Orthopaedic Surgery Part I Certification Examination.","authors":"Erik Fritz, Michael Bednar, John Harrast, David F Martin, Mona Saniei, Paul Tornetta, Ann Van Heest","doi":"10.5435/JAAOS-D-24-00544","DOIUrl":"10.5435/JAAOS-D-24-00544","url":null,"abstract":"<p><strong>Introduction: </strong>Since 2020, the American Academy of Orthopaedic Surgeons (AAOS) and American Board of Orthopaedic Surgery (ABOS) have collaborated to link the AAOS Orthopaedic In-Training Examination (OITE) and the ABOS part I Certification Examination, allowing the identification of a minimum score on each annual OITE that corresponds to a minimum passing part I score. The purpose of this study is to assess the performance of this examination linking over these past 3 years.</p><p><strong>Methods: </strong>From 2020 to 2022, the AAOS provided each graduating resident's OITE score; from 2021 to 2023, the ABOS provided each examinee's ABOS part I pass-fail result. Examination scores were matched at the individual level and deidentified for data analysis.</p><p><strong>Results: </strong>A total of 2,247 subjects took both the OITE and the ABOS during the same cycle, during the 3-year study period. The ABOS part I pass rates in 2021, 2022, and 2023 were 92.9%, 98.1%, and 98.4%, respectively, for those taking the OITE the prior year. The positive predictive value of achieving the minimum passing score on the OITE for passing part I increased from 95.1% in 2021 to 99.8% and 99.7% in 2022 and 2023, respectively. The negative predictive value of not achieving the minimum passing score on the OITE for failing part I decreased from 24.7% in 2021 to 5.3% in 2022 and 10.1% in 2023.</p><p><strong>Discussion: </strong>This study is the first of its kind and demonstrates the initial results of the examination linking between the OITE and the ABOS part I Examination. This information can be helpful for residents and residency program directors. Moreover, the examination linking provides a step toward obtaining a standardized assessment of knowledge throughout all 5 years of residency.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Challenges of Using ChatGPT for Clinical Decision Support in Orthopaedic Surgery: A Pilot Study.","authors":"Michael A McNamara, Brandon G Hill, Peter L Schilling","doi":"10.5435/JAAOS-D-24-01072","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01072","url":null,"abstract":"<p><strong>Background: </strong>Artificial intelligence (AI) technologies have recently exploded in both accessibility and applicability, including in health care. Although studies have demonstrated its ability to adequately answer simple patient issues or multiple-choice questions, its capacity for deeper complex decision making within health care is relatively untested. In this study, we aimed to delve into AI's ability to integrate multiple clinical data sources and produce a reasonable assessment and plan, specifically in the setting of an orthopaedic surgery consultant.</p><p><strong>Methods: </strong>Ten common fractures seen by orthopaedic surgeons in the emergency department were chosen. Consult notes from patients sustaining each of these fractures, seen at a level 1 academic trauma center between 2022 and 2023, were stripped of patient data. The history, physical examination, and imaging interpretations were then given to ChatGPT4 in raw and semistructured formats. The AI was asked to determine an assessment and plan as if it were an orthopaedic surgeon. The generated plans were then compared with the actual clinical course of the patient, as determined by our multispecialty trauma conference.</p><p><strong>Results: </strong>When given both raw and semistructured formats of clinical data, ChatGPT4 determined safe and reasonable plans that included the final clinical outcome of the patient scenario. Evaluating large language models is an ongoing field of research without an established quantitative rubric; therefore, our conclusions rely on subjective comparison.</p><p><strong>Conclusion: </strong>When given history, physical examination, and imaging interpretations, ChatGPT is able to synthesize complex clinical data into a reasonable and most importantly safe assessment and plan for common fractures seen by orthopaedic surgeons. Evaluating large language models is an ongoing challenge; however, using actual clinical courses as a \"benchmark\" for comparison presents a possible avenue for further research.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143735777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior Intrapelvic Approach: A Comprehensive Understanding of the Anatomy.","authors":"Guillaume David, Claude H Sagi, Pierre Guy, Cyril Mauffrey","doi":"10.5435/JAAOS-D-24-01050","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01050","url":null,"abstract":"<p><p>The anterior intrapelvic (AIP) approach has become a standard technique for the fixation of acetabular fractures. While the critical steps for performing the AIP approach are well described in the literature, a comprehensive overview of the anatomical structures at risk remains limited. This review aims to provide an in-depth understanding of the AIP approach with a focus on the historically \"nonorthopaedic\" surgical anatomy and associated risks. Ultimately, this knowledge empowers orthopaedic trauma surgeons to perform acetabular surgery with improved exposure, safety, and confidence.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Pain Management in Patients Being Treated for Opioid Use Disorder: The Orthopaedic Surgeon's Role and Strategies for Comprehensive Care.","authors":"Emily Benson, Tipu Khan, Hillary Rolfs, Niaz Ahankoob","doi":"10.5435/JAAOS-D-24-00786","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00786","url":null,"abstract":"<p><p>Approximately 280,000 deaths in this country were attributed to opioid overdose between 1999 and 2021, increasing fivefold within this period. Orthopaedic surgeons have had a large contribution to this epidemic; they have been found to be the third highest prescribers of opioid medications. Multiple pharmacologic and nonpharmacologic treatment options for opioid use disorder (OUD) have been developed. The three most commonly used medications are methadone, buprenorphine, and naltrexone. In part owing to the use of these medications, states such as Oregon have seen a 20% decrease in opioid abuse and a 30% decrease in fatal overdoses. Historically, orthopaedic surgeons receive minimal formal training on managing postoperative pain in patients with OUD. Patients with OUD may experience neuroplastic changes from long-term exposure to opioids, which, in turn, diminish the analgesic effect of opioid medications in the acute postoperative period. Patients become more sensitive to painful stimuli, ultimately leading to loss of opioid efficacy. Undertreating pain may contribute to unnecessary patient suffering and can lead to mistrust within the patient-physician relationship. Overtreating pain may have catastrophic consequences such as disruption of sobriety, respiratory compromise, and death. It is recommended to include a pain management specialist or service during the perioperative period, if possible. This article clarifies the orthopaedic surgeon's role in the perioperative care of this patient population by providing an overview of medications used to treat OUD, pain control strategies, psychosocial concerns, and legal considerations, with the goal of streamlining care to improve patient safety and outcomes.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Crossing the Cervicothoracic Junction on Opioid Consumption, Readmission, and Revision Rates.","authors":"Gregory Toci, Rajkishen Narayanan, Michael Carter, Jonathan Dalton, Rachel Huang, Andrew Vanichkachorn, Andrew Kim, Asad Pasha, Nathaniel Pineda, Mark Kurd, Ian David Kaye, Thomas Cha, Barrett Woods, Jose Canseco, Alan Hilibrand, Alexander Vaccaro, Christopher Kepler, Gregory Schroeder","doi":"10.5435/JAAOS-D-24-01197","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01197","url":null,"abstract":"<p><strong>Introduction: </strong>The risks and benefits of extending posterior cervical decompression and fusion (PCDF) constructs across the cervicothoracic junction (CTJ) remain controversial. Previous studies have used fusions beginning at different levels and varying in construct length. There are no studies that examine the effect of crossing the CTJ on opioid consumption. This study aims to compare short-term and long-term postoperative outcomes among patients undergoing PCDF at C3 and ending at C7, T1, or T2.</p><p><strong>Methods: </strong>Adult patients who underwent C3-C7, C3-T1, and C3-T2 PCDF from 2017 to 2022 were identified. All patients were retrospectively reviewed for demographic and surgical information. Perioperative opioid utilization from 1 year preoperatively to 1 year postoperatively was obtained from the Pennsylvania Prescription Drug Monitoring Program (PDMP). Acute postoperative outcomes included rates of 30-day and 90-day readmission and any revision surgery.</p><p><strong>Results: </strong>This study included 72 (C3-C7: 30.2%), 143 (C3-T1: 60.1%), and 23 (C3-T2: 9.7%) patients-groups were demographically similar. The average length of follow-up was 503 ± 433 days. Cut-to-close time differed between groups (166 ± 37.9 [C3-C7] vs. 182 ± 43.2 vs. 199 ± 40.9 minutes [C3-T2]; P = 0.003). Total in-hospital morphine milligram equivalents (205 ± 136 [C3-C7] vs. 247 ± 191 vs. 285 ± 136 [C3-T2]; P = 0.007) and average daily in-hospital morphine milligram equivalents (59.5 ± 29.9 [C3-C7] vs. 73.2 ± 52.1 vs. 81.0 ± 22.9 [C3-T2]; P = 0.008) were highest among C3-T2 fusions. Patients who underwent C3-T2 fusion consumed higher MMEs from 0 to 90 days postoperatively (148 ± 197 [C3-C7] vs. 223 ± 307 vs. 260 ± 363 [C3-T2]; P = 0.027). Length of stay, opioid use beyond 90 days, 30-day and 90-day readmission rates, revision surgery rates, and revision rates were similar between groups.</p><p><strong>Conclusion: </strong>Crossing the CTJ increased cut-to-close time and early postoperative opioid consumption but did not affect length of stay, readmission rates, long-term opioid misuse, or revision surgery rates.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"GPT-4 as a Source of Patient Information for Carpal Tunnel Surgery: A Comparative Analysis Against Google Web Search.","authors":"Paul G Mastrokostas, Aaron B Lavi, Bruce B Zhang, Leonidas E Mastrokostas, Scott Liu, Katherine M Connors, Jennifer Hashem","doi":"10.5435/JAAOS-D-24-00249","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-00249","url":null,"abstract":"<p><strong>Introduction: </strong>Carpal tunnel surgery (CTS) accounts for approximately 577,000 surgeries in the United States annually. This high frequency raises concerns over the dissemination of medical information through artificial intelligence chatbots, Google, and healthcare professionals. The objectives of this study are to determine whether GPT-4 and Google differ in (1) the type of questions asked, (2) the readability of responses, and (3) the accuracy of numerical responses for the top 10 most frequently asked questions (FAQs) about CTS.</p><p><strong>Methods: </strong>A Google search was conducted to identify the top 10 FAQs related to CTS, which were then queried in GPT-4. Responses were categorized using the Rothwell classification system and evaluated for readability using Flesch Reading Ease and Flesch-Kincaid grade level scores. Statistical analyses included Cohen kappa coefficients for interobserver reliability and Student t-tests for comparing response characteristics. Statistical significance was set at the 0.05 level.</p><p><strong>Results: </strong>This study found that 70% of Google's FAQs were fact based, predominantly focusing on technical details (40%) and specific activities (40%). GPT-4's FAQs were mainly factual (50%), with technical details (40%) being the most queried topic. Complete agreement in interobserver reliability was observed. Google's answers were more readable than GPT-4's, with a Flesch Reading Ease score of 56.40 vs. 34.19 (P = 0.001) and a Flesch-Kincaid grade level of 9.93 vs. 12.85 (P = 0.007). Google responses were shorter, with an average word count of 91.50 compared with GPT-4's 162.90 (P = 0.013). For numerical responses to FAQs, GPT-4 and Google differed in nine out of 10 questions, with GPT-4 often providing broader time frames.</p><p><strong>Conclusion: </strong>GPT-4 offers a more detailed and technically oriented approach to addressing patient queries about CTS when compared with Google. This suggests that GPT-4 can offer detailed insights where patients seek more in-depth information, enhancing the quality of healthcare education.</p><p><strong>Level of evidence: </strong>NA.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application and Analysis of the Enhanced Recovery After Surgery Opioid Prescription Protocol in Arthroscopy and Arthroplasty Patients.","authors":"Wali U Pirzada, Simran Shamith, Thalia Le, Terence L Thomas, Sina Ramtin, Asif M Ilyas","doi":"10.5435/JAAOS-D-24-01232","DOIUrl":"https://doi.org/10.5435/JAAOS-D-24-01232","url":null,"abstract":"<p><strong>Introduction: </strong>Surgery and postoperative opioid prescriptions are critical periods for potential drug dependence and diversion. Enhanced recovery after surgery (ERAS) pathways aim to improve patient outcomes by leveraging preoperative education, emphasizing nonopioid pain management, and using less invasive surgical techniques. The study hypothesis was that the use of ERAS pathways would decrease postoperative opioid prescribing after arthroscopy and arthroplasty surgeries.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on patients treated by 11 orthopaedic surgeons at 9 Iowa hospitals from November 2022 to March 2024. Patients were divided into arthroplasty (n = 67) and arthroscopy (n = 33) cohorts. Opioids prescribed before and after ERAS implementation were measured and converted to morphine milligram equivalents (MMEs). Statistical analyses included the Wilcoxon signed rank test, Mann-Whitney U test, and chi-squared test.</p><p><strong>Results: </strong>The mean pre-ERAS prescription size was 389 MMEs (range: 140 to 900 MMEs) for the overall cohort postoperatively, with arthroplasty at 451 MMEs (range: 200 to 900 MMEs) and arthroscopy at 264 MMEs (range: 140 to 450 MMEs). After ERAS, the overall mean size dropped to 194 MMEs (range: 38 to 600 MMEs), with arthroplasty at 210 MMEs (range: 38 to 600 MMEs) and arthroscopy at 161 MMEs (range: 45 to 315 MMEs). Both cohorts saw significant reductions, with a mean 47% reduction in arthroplasty and a mean 33% reduction in arthroscopy (both P < 0.001). Statistical analysis found percent reduction of prescription size to be greater in the arthroplasty cohort than in the arthroscopy cohort (P < 0.001). Arthroscopy patients had a higher mean percentage of MMEs prescribed leftover (60%) compared with arthroplasty patients (27%; P< 0.001).</p><p><strong>Conclusion: </strong>The study hypothesis was upheld as ERAS pathways resulted in a notable reduction in prescribing of opioids postoperatively after both arthroplasty and arthroscopic surgeries. ERAS pathways should continue to be tailored and studied to improve postoperative recovery while decreasing the reliance on opioids postoperatively for pain management.</p>","PeriodicalId":51098,"journal":{"name":"Journal of the American Academy of Orthopaedic Surgeons","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}