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

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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

Description

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

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