Surgeon Variation in Perioperative Opioid Prescribing and Medium or Long Term Opioid Utilization After Total Knee Arthroplasty: A Cross-Sectional Analysis. Anesthesiology Cen, X., Jena, A. B., Mackey, S., Sun, E. C. 2022

Abstract

BACKGROUND: Whether a particular surgeon's opioid prescribing behavior is associated with prolonged postoperative opioid use is unknown. We tested the hypothesis that the patients of surgeons with a higher propensity to prescribe opioids are more likely to utilize opioids long-term postoperatively.METHODS: We identified 612,378 Medicare fee-for-service patients undergoing total knee arthroplasty between January 1, 2011 and December 31, 2016. We then defined "high-intensity" surgeons as those whose patients were, on average, in the upper quartile of opioid utilization in the immediate perioperative period (preoperative day 7 to postoperative day 7), We then estimated whether patients of "high-intensity" surgeons had higher opioid utilization in the mid-term (postoperative days 8-90) and long-term (postoperative days 91-365), utilizing an instrumental variables approach to minimize confounding from unobservable factors.RESULTS: In the final sample of 604,093 patients, the average age was 74 years (SD 5) and there were 413,121 (68.4%) females. 180,926 patients (30%) were treated by "high-intensity" surgeons. On average, patients receiving treatment from a "high-intensity" surgeon received 36.1 (SD 35.0) oral morphine equivalents (MME)/day during the immediate perioperative period compared to 17.3 MME (SD 23.1) per day for all other patients (+18.9 MME/day difference; 95%CI 18.7 to 19.0; p<0.001). After adjusting for confounders, receiving treatment from a "high-intensity" surgeon was associated with higher opioid utilization in the mid-term opioid postoperative period (+2.4 MME/day difference, 95%CI 1.7 to 3.2, p<0.001, [11.4 MME/day vs 9.0]), and lower opioid utilization in the long-term postoperative period (-1.0 MME/day difference, 95%CI -1.4 to -0.6, p<0.001, [2.8 MME/day vs 3.8]). While statistically significant, these differences were clinically small.CONCLUSIONS: Among Medicare fee-for-service patients undergoing total knee arthroplasty, surgeon-level variation in opioid utilization in the immediate perioperative period was associated with statistically significant but clinically insignificant differences in opioid utilization in the medium- and long-term postoperative periods.

View details for DOI 10.1097/ALN.0000000000004259

View details for PubMedID 35503990