Surgical Opioid Stewardship for Orthopedic Surgery: A Quality Improvement Initiative.

The aim of this quality improvement initiative was to reduce unnecessary opioid prescribing by sharing data with prescribers on opioid use by patients. In our study, transition of care clinicians performed follow-up phone calls to select postoperative orthopedic patients to determine opioid use. We implemented a standardized postoperative 7-day opioid wean and designed a dashboard to track the information gathered. We calculated descriptive statistics for continuous and categorical variables. In the initial assessment of opioid use by orthopedic patients, the study consisted of 296 patients with a mean age of 64.8±11.4 years, 147 females (49.7%) and 149 males (50.3%), 59.1% joint replacements (hip, knee, shoulder), and 40.9% spine surgeries (lumbar decompression, cervical fusion, hemilaminectomy). Among those prescribed an opioid, 50% received a prescription for 30 pills or less and 52.4% reported taking more than 80% of the opioid pills, while 35.1% reported taking less than 60%. In the prescribing quality improvement assessment, there were a total of 1547 hospitalizations for joint replacement surgeries from June 2018 to June 2020: 774 (50.0%) hips and 773 (50.0%) knees. There was a significant difference in morphine milligram equivalents per day and quantity prescribed when comparing the preintervention period with the postintervention period without significant increases in opioid refill requests or return visit rates. In our study, sharing data around patient opioid use and provider-facing prescribing metrics reduced postoperative opioid prescribing without significantly increasing opioid refill or emergency department return visit rates. [Orthopedics. 2023;46(4):e230-e236.].

Evaluation of reducing postoperative hip precautions in total hip replacement: a randomized prospective study.

Currently, many rehabilitation protocols for total hip replacements (THRs) include activity restrictions to prevent postoperative dislocation. There is increasing demand for more efficient and safe rehabilitation protocols. This randomized prospective study evaluates the need for hip restrictions following a modified anterolateral procedure. From 2004 to 2008, 81 patients seeking elective THRs were randomly assigned into a standard rehabilitation group or an early rehabilitation group. The standard group included restrictions to avoid hip flexion >90 degrees and avoidance of riding in a car for the first postoperative month. The early group had no flexion or car riding restrictions. Forty-three patients were in the standard group and 38 patients were in the early group. There were no significant demographic differences between the 2 groups. All patients completed the Short Form 12-question Health Survey and Harris Hip Score preoperatively and at 4 weeks, 1 month, 3 months, and 1 year postoperatively. The time-points at which the patient first drove and ambulated with a cane, without a cane, and without a limp were also collected. No incidents of dislocation occurred. Patients in the early group were faster to ambulate with only a cane (P=.03), without a cane (P<.001), and without a limp (P=.003). They also drove earlier (P=.02). Pace of recovery was the only significant difference between the 2 groups. The early rehabilitation protocol increases the pace of recovery compared to a pathway with hip precautions without increasing complications.