The Effect of Opioid Consumption on Patient Satisfaction in TJA

In light of the opioid epidemic, there has been concern surrounding narcotic prescriptions, particularly when it comes to orthopedic surgeries, which can result in significant postoperative pain. A study evaluated the correlation between opioid consumption and patient satisfaction in total joint arthroplasty (TJA) patients.

“Patient satisfaction has become an important metric for joint arthroplasty (TJA) used to reimburse hospitals. Despite ubiquitous narcotic use for post-TJA pain control, there is little understanding regarding patient factors associated with obtaining opioid refills and associations with patient satisfaction,” the researchers observed.

They conducted a review of pre- and postoperative narcotic prescriptions filled for 438 consecutive TJA patients per their state’s mandatory opioid prescription monitoring program. Patients were stratified into three groups: zero, one, or more than one postoperative narcotic refills obtained. Demographics, surgical factors, and pain control satisfaction were compared among the groups.

About a quarter of patients (n=125; 25.8%) took no preoperative opioids and had no postoperative refills. Factors associated with having zero post-discharge refills included undergoing total hip arthroplasty (THA) (P=0.0004), age ≥65 years (P=0.0057), and Medicare insurance (P=0.0058). THA patients were significantly less likely to receive a refill narcotic (adjusted odds ratio [aOR]=0.373; 95% confidence interval [CI], 0.224 to 0.622). For every 100-morphine milligram equivalent (MME) in preoperative opioid use, there was a 16% increase in the likelihood to require more than one opioid refill (aOR=1.161; 95% CI, 1.085 to 1.242). Satisfaction was higher among patients who consumed less opioids overall when they got a refill (436 MMEs vs. 1,119 MMEs; P=0.021).

The analysis was published in The Journal of Arthroplasty.

“Subjects who received fewer narcotic prescriptions and overall MMEs demonstrated higher rates of satisfaction with early pain control. Our results are consistent with other studies in showing that increased pre-operative narcotic use portends higher rates of post-operative refills. There appears to be a subset of THA patients >65 years of age who may be candidates for opioid-sparing analgesia,” the researchers summarized.