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J Knee Surg 2021; 34(11): 1196-1204
DOI: 10.1055/s-0040-1702183
Original Article

Inpatient Opioid Consumption Variability following Total Knee Arthroplasty: Analysis of 4,038 Procedures

Mackenzie A. Roof
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
,
Connor W. Sullivan
2   Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
,
James E. Feng 
3   NYU Langone Orthopedics, NYU Langone Health, New York, New York
,
Afshin A. Anoushiravani
2   Division of Orthopaedic Surgery, Albany Medical Center, Albany, New York
,
Daniel Waren
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
,
Scott Friedlander
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
,
Claudette M. Lajam
3   NYU Langone Orthopedics, NYU Langone Health, New York, New York
,
Ran Schwarzkopf
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
,
James D. Slover   *
1   Department of Orthopedic Surgery, NYU Langone Health, New York, New York
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Abstract

This study examined an early iteration of an inpatient opioid administration-reporting tool, which standardized patient opioid consumption as an average daily morphine milligram equivalence per surgical encounter (MME/day/encounter) among total knee arthroplasty (TKA) recipients. The objective was to assess the variability of inpatient opioid administration rates among surgeons after implementation of a multimodal opioid sparing pain protocol. We queried the electronic medical record at our institution for patients undergoing elective primary TKA between January 1, 2016 and June 30, 2018. Patient demographics, inpatient and surgical factors, and inpatient opioid administration were retrieved. Opioid consumption was converted into average MME for each postoperative day. These MME/day/encounter values were used to determine mean and variance of opioids prescribed by individual surgeons. A secondary analysis of regional inpatient opioid consumption was determined by patient zip codes. In total, 23 surgeons performed 4,038 primary TKA. The institutional average opioid dose was 46.24 ± 0.75 MME/day/encounter. Average intersurgeon (IS) opioid prescribing ranged from 17.67 to 59.15 MME/day/encounter. Intrasurgeon variability ranged between ± 1.01 and ± 7.51 MME/day/encounter. After adjusting for patient factors, the average institutional MME/day/encounter was 38.43 ± 0.42, with average IS variability ranging from 18.29 to 42.84 MME/day/encounter, and intrasurgeon variability ranging between ± 1.05 and ± 2.82 MME/day/encounter. Our results suggest that there is intrainstitutional variability in opioid administration following primary TKA even after controlling for potential patient risk factors. TKA candidates may benefit from the implementation of a more rigid standardization of multimodal pain management protocols that can control pain while minimizing the opioid burden. This is a level of evidence III, retrospective observational analysis.

Keywords

total knee arthroplasty - total joint arthroplasty - pain management - opioid epidemic - opioids - analgesics

* Senior author




Publication History

Received: 05 June 2019

Accepted: 07 January 2020

Article published online:
20 April 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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