Impact of an Opioid Stewardship Initiative Involving Early Conversion to Oral Narcotics in Postoperative Orthopaedic Patients


The objective of this study was to determine if the implementation of an opioid stewardship initiative involving early conversion to oral opioids improves outcomes in postoperative orthopaedic patients. This single-center retrospective chart review compared adult patients undergoing lower extremity orthopaedic procedures during a specified six-month time period. The primary outcome was total opioid utilization in morphine milligram equivalence (MME) at 48-hours post-surgery. Four hundred ninety-five patients were included in the study, 233 in the intervention group and 262 in the pre-intervention group. The average pain scores at 12, 24 and 48 hours postoperatively were similar among the two groups. After a multivariate linear regression was performed, a 22.9 MME reduction was estimated in the post-implementation group compared to the pre-implementation group (p = 0.003). Based on these results, it appears that converting from intravenous to oral narcotics 24-hours post-orthopaedic surgery reduces total mean MMEs while providing similar pain control. (Journal of Surgical Orthopaedic Advances 31(2):086–089, 2022)

Key words: morphine milligram equivalence, opioid stewardship, oral narcotics, orthopaedic surgery, pain scores

Jacklyn Downey, PharmD; John D. Adams Jr, MD; Stephanie Tanner, MS; Li He; and Michael Wagner, PharmD