J Am Acad Orthop Surg. 2025 Mar 25. doi: 10.5435/JAAOS-D-24-01232. Online ahead of print.
ABSTRACT
INTRODUCTION: Surgery and postoperative opioid prescriptions are critical periods for potential drug dependence and diversion. Enhanced recovery after surgery (ERAS) pathways aim to improve patient outcomes by leveraging preoperative education, emphasizing nonopioid pain management, and using less invasive surgical techniques. The study hypothesis was that the use of ERAS pathways would decrease postoperative opioid prescribing after arthroscopy and arthroplasty surgeries.
METHODS: A retrospective chart review was conducted on patients treated by 11 orthopaedic surgeons at 9 Iowa hospitals from November 2022 to March 2024. Patients were divided into arthroplasty (n = 67) and arthroscopy (n = 33) cohorts. Opioids prescribed before and after ERAS implementation were measured and converted to morphine milligram equivalents (MMEs). Statistical analyses included the Wilcoxon signed rank test, Mann-Whitney U test, and chi-squared test.
RESULTS: The mean pre-ERAS prescription size was 389 MMEs (range: 140 to 900 MMEs) for the overall cohort postoperatively, with arthroplasty at 451 MMEs (range: 200 to 900 MMEs) and arthroscopy at 264 MMEs (range: 140 to 450 MMEs). After ERAS, the overall mean size dropped to 194 MMEs (range: 38 to 600 MMEs), with arthroplasty at 210 MMEs (range: 38 to 600 MMEs) and arthroscopy at 161 MMEs (range: 45 to 315 MMEs). Both cohorts saw significant reductions, with a mean 47% reduction in arthroplasty and a mean 33% reduction in arthroscopy (both P < 0.001). Statistical analysis found percent reduction of prescription size to be greater in the arthroplasty cohort than in the arthroscopy cohort (P < 0.001). Arthroscopy patients had a higher mean percentage of MMEs prescribed leftover (60%) compared with arthroplasty patients (27%; P< 0.001).
CONCLUSION: The study hypothesis was upheld as ERAS pathways resulted in a notable reduction in prescribing of opioids postoperatively after both arthroplasty and arthroscopic surgeries. ERAS pathways should continue to be tailored and studied to improve postoperative recovery while decreasing the reliance on opioids postoperatively for pain management.
PMID:40127220 | DOI:10.5435/JAAOS-D-24-01232
