Opioid Prescribers to Total Joint Arthroplasty Patients Before and After Surgery: The Majority Are Not Orthopedists

Background: Improved narcotic pain management after total joint arthroplasty (TJA) is necessary to help battle the opioid epidemic. The goal of this study was to determine the sources of prescriptions prescribed to TJA patients. Methods: An evaluation of opioid use in patients undergoing primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) was performed between 2008 and 2012. Using a Total Joint Replacement Registry and pharmacy data, opioids dispensed to TJA patients were identified. The main outcome of interest was who prescribed opioids to patients in the year before and after surgery. Results: Primary care (pre-TKA 31% TKA, post-TKA 38%, pre-THA 34%, post-THA 40%) and internal medicine (27% pre-TKA, post-TKA 37%, pre-THA 32%, post-THA 40%) were the highest prescribers in the year before, and after, TJA. For TKA patients, orthopedists prescribed 9% of the opioids in the year before surgery, 47% in days 1-90 after surgery, and 14% in days 271-360. Similarly, in THA patients, orthopedists prescribed 14% of the opioids in the year before surgery, 40% in days 1-90 after surgery, and 14% in days 271-360. Conclusion: Patients receive opioid prescriptions from multiple physician types before, and after, TJA. The majority of preoperative, and late postoperative, narcotics were not provided by their surgeons. Orthopedic surgeons may not even know that their TJA patients continue to receive opioids. Coordination of opioid care with health-care providers and greater communication with patients on narcotic use expectations should be promoted. (C) 2018 Elsevier Inc. All rights reserved.