Patients at Risk: Large Opioid Prescriptions After Total Knee Arthroplasty

Background: Opioids are an effective, and often necessary, treatment of postoperative pain after total knee arthroplasty (TKA). However, it is often difficult to know how much medication patients will need after discharge. The purpose of this study was to determine if patients discharged with greater quantities of opioids after TKA are more likely to request refills. Methods: This is a retrospective review of 105 primary TKAs performed with at least 1 year of follow-up. Exclusion criteria included bilateral TKA, preoperative opioid use, or reoperation within the first 3 months. Data collected included opioid refills, Knee Society Score, and total and daily morphine equivalent dose (MED) prescribed. Results: Patients were most commonly discharged on oxycodone (90%), hydromorphone (5%), and hydrocodone/acetaminophen (1%). The average total prescribed MED was 1405 +/- 616 mg (range, 273-3250 mg). Patients requiring refills did not differ in the total prescribed MED (1521 +/- 624 vs 1349 +/- 609 mg; P = .1), daily prescribed MED (153 +/- 10 vs 155 +/- 7 mg; P = .8), or preoperative Knee Society Score (63 +/- 16 vs 60 +/- 13; P = .3). Average follow-up time was 2.4 +/- 0.5 years. Conclusion: The quantity of opioids prescribed after TKA varied widely, ranging from a total MED of 273-3250 mg. The refill rate did not differ between large prescriptions (>1400 mg) and smaller prescriptions. Excessive opioid prescriptions should be avoided as they did not decrease the number of refills and pose the risk of divergence and subsequent abuse. (C) 2017 Elsevier Inc. All rights reserved.