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
