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- Title
Effects of Opioid-Limiting Legislation and Increased Provider Awareness on Postoperative Opioid Use and Complications After Hip Arthroscopy.
- Authors
Strony, John T.; Raji, Yazdan; Ina, Jason G.; Yu, Jiao; Megerian, Mark F.; McCollum, Samuel W.; Mather III, Richard C.; Nho, Shane J.; Salata, Michael J.
- Abstract
Background: On August 31, 2017, Ohio passed legislation that regulates how opioids can be prescribed postoperatively. Studies have shown that such legislation is successful in reducing the morphine milligram equivalents (MMEs) prescribed after certain orthopaedic procedures. Purpose: (1) To determine if the opioid prescription–limiting legislation in Ohio reduced the cumulative MMEs prescribed after hip arthroscopy without significantly affecting the rates of emergency department (ED) visits, hospital readmissions, and reoperations within 90 days postoperatively, and (2) to assess risk factors associated with increased postoperative opioid dosing. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients who underwent primary and revision hip arthroscopy at a single institution over a 4-year period. The prelegislation (PRE) and postlegislation (POST) groups were defined as patients who underwent surgery before August 31, 2017, and on/after this date, respectively. The Ohio Automated Rx Reporting System was queried for controlled-substance prescriptions from 30 days preoperatively to 90 days postoperatively, and patient medical records were reviewed to collect demographic, medical, surgical, and readmission data. Inverse probability weighting–adjusted mean treatment effect regression models were used to measure the difference in mean outcomes between the PRE and POST cohorts. Results: A total of 546 patients (228 PRE, 318 POST) were identified. There was a 25% reduction in the cumulative MMEs prescribed to the POST group as compared with the PRE group during the first 90 days postoperatively (840 vs 1125 MME, respectively; P <.01). The legislation was associated with a significant decrease in the cumulative MMEs prescribed in the first 90 postoperative days (mean treatment effect = –280.6; P <.01), and there were no significant between-group differences in the frequency of ED encounters (8.8% PRE, 11.6% POST; P =.32), hospital readmissions (1.3% PRE, 0.9% POST; P =.70), or reoperations (0.9% PRE, 0.6% POST; P ≥.99) during this period. Preoperative opioid use was a significant independent risk factor for increased cumulative MMEs in the first 90 days postoperatively (β = 275; P <.01). Conclusion: Opioid prescription–limiting legislation in Ohio was associated with significant reductions in opioid MMEs dosing in the 90-day period following hip arthroscopy. This legislation had no significant effect on ED utilization, hospital readmissions, or reoperations within the same period. Preoperative opioid use was a significant risk factor for increased MME dosing after hip arthroscopy.
- Subjects
OHIO; CONTROLLED substance laws; DRUG laws; HIP surgery; PREOPERATIVE care; KRUSKAL-Wallis Test; PROFESSIONS; HOSPITAL emergency services; ARTHROSCOPY; MULTIPLE regression analysis; MULTIVARIATE analysis; POSTOPERATIVE care; PATIENT readmissions; SURGERY; PATIENTS; ACQUISITION of data; MANN Whitney U Test; RETROSPECTIVE studies; MORPHINE; RISK assessment; COMPARATIVE studies; PRE-tests &; post-tests; REOPERATION; DRUG prescribing; MEDICAL records; DESCRIPTIVE statistics; OPIOID analgesics; PHYSICIAN practice patterns; DRUG utilization; LOGISTIC regression analysis; DATA analysis software; POSTOPERATIVE pain; LONGITUDINAL method
- Publication
Orthopaedic Journal of Sports Medicine, 2023, Vol 11, Issue 5, p1
- ISSN
2325-9671
- Publication type
Article
- DOI
10.1177/23259671231162340