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Older age, good pain control may reduce narcotic refill rate after TKA
Risk of requiring narcotic refill following total knee arthroplasty may be lower among elderly patients and patients with good pain control postoperatively, according to study results.
“Several studies have done excellent work attempting to lower the amount of narcotics provided to patients postoperatively in order to help combat the opioid crisis. One way that this has been accomplished is to standardize the amount of postoperative narcotics given for a particular procedure,” Benjamin K. Wilke, MD, co-author of the study, told Healio.com/Orthopedics. “While helpful, we believe this method is too simplistic and does not treat patients as individuals. In this study, we wanted to further refine our prescribing practice and determine if there are patients at lower risk of requiring a refill, allowing us to provide these patients with fewer narcotics at discharge than we otherwise would for a given procedure.”
To determine risk factors for requiring a prescription refill following hospital discharge, Wilke and colleagues performed multivariable analysis on demographics and preoperative, operative and postoperative characteristics among 157 patients undergoing TKA who were narcotic-naïve.
Results showed prescription refills were required among 60% of patients. Researchers found patients who were younger and patients who had increased pain on postoperative day 1 were at increased risk of requiring a prescription refill postoperatively. However, the refill rate was not independently affected by the amount of narcotic medication given at discharge, according to results.
“We discovered that older patients and those whose pain was well-controlled on postoperative day 1 were at a lower risk of requesting a refill postoperatively,” Wilke said. “With this information, we are now able to begin tailoring our prescriptions, further reducing the amount of narcotics given to this lower-risk population.” – by Casey Tingle
Disclosure: Wilke reports no relevant financial disclosures.
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The paper by Benjamin K. Wilke, MD, and colleagues was a retrospective review of 157 postoperative TKA patients to determine what factors predict an increased need for postoperative narcotic pain medication refill. Sixty percent of this patient cohort requested a narcotic prescription refill after discharge. Patients who were younger age (66 vs. 75 years) and had higher average numerical rating scale pain scores on postoperative day 1 were at increased likelihood of requesting narcotic prescription refill following TKA.
This study attempts to provide physicians with more information to tailor postoperative narcotic needs to each patient and thus to cut back on the amount of unused narcotics. Orthopedic surgeons are the third-highest opioid prescriber in the U.S. and therefore must make efforts to help reduce the amount of unused narcotics available to help curtail the opioid crisis. Although this study provides some insight into ways to adjust postoperative narcotic prescriptions, the study is limited by its retrospective design, small sample size and lack of adequate power to rely on its conclusions.
Brigham and Women’s Hospital
Harvard Medical School