Opioid Administration Patterns and Trends following Total Joint Arthroplasty: A Multi-Center Analysis

Objectives: The opioid epidemic has become a public health crisis, with orthopedic surgeons among the highest prescribers of opioids. Total joint arthroplasty (TJA) represents a large portion of orthopedic surgeries performed annually, with opioids commonly utilized in post-operative pain management. Understanding opioid administration patterns following TJA is important to better inform post-operative pain management prescribing and reduce opioid reliance in postoperative care. The purpose of this study was to characterize opioid use following TJA across various healthcare institutions and settings. Methods: A 5-year retrospective study was performed utilizing patient data collected by Avalon.ai from 3 large health systems around the US. The data was screened for patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) between 2018 and 2022 (n=4,472). Patient records were screened for administration of opioids following TJA, defined as average morphine milligram equivalents (MME). Results: The average MME for combined TKA (n=2,913) and THA (n=1,571) increased significantly from 24 ± 18 in 2018 to 33 ± 28 in 2022 (P <.0001). Average MME increased for TKA from 26 ± 19 in 2018 to 35 ± 27 in 2022 (P <.0001) and THA from 23 ± 16 in 2018 to 27 ± 31 in 2022 (P <0.03). Additionally, the average MME was higher following inpatient TJA than outpatient, with variation in MME amongst healthcare institutions in recent years. Conclusion: Opioid administration following TJA increased annually over the study period, with significant variation in average MME following TJA across healthcare institutions. Continued efforts are needed to deploy evidenced-based post-operative pain management after TJA to avoid over-prescribing opioids, minimize inter-institutional variability, and maximize patient experience.