Opioid Tapering Prior to Total Knee and Total Hip Arthroplasty
The overarching purpose of this study is to provide pilot data towards a future larger grant proposal seeking to understand if patients undergoing TKA/THA can successfully taper off of or significantly reduce opioids prior to surgery when given information about the risks of using opioids prior to surgery and to determine how patients and providers respond to a “reminder” about the risk of elective surgery in the opioid exposed patient. To do so, this project will identify patients on opioids prior to arthroplasty and provide those patients and their provider’s with information about the benefits of tapering off opioids. Specifically, we will modify the HOT initiative to include the rationale for tapering opioids prior to arthroplasty and patients will be given this information in a letter and their provider will make a recommendation to taper. Patients enrolled in methadone maintenance programs, those taking buprenorphine for addiction management and patients receiving intrathecal opioid therapy will be excluded. Research staff will follow enrolled patients in order to better understand changes in opioid use prior to surgery and other outcomes in the pre- and post-operative period. Initial baseline assessments will take place when patients are seen in the orthopedic clinic and surgery has been recommended. Additional assessments will take within 1 week of surgery to assess if patients were actually tapered and longitudinally following surgery. This work will be complimented with qualitative data from focus groups with patients scheduled for a TKA and THA and providers involved in surgical interventions for pain.
In this pilot study, we sought to gain a better understanding of what patient barriers exist in relation to tapering opioid medications prior to undergoing a surgical procedure for pain. Given our present lack of knowledge in this area, it is difficult to implement perioperative tapering and a better understanding of motivating factors and barriers will inform future efforts at perioperative taper. Our study demonstrated that: A. Patients do not want to be told to taper by a surgeon and prefer this information come from a PCP or opioid provider. B. Fear of increased pain was a common reason why patients were unable to taper. C. Getting family members involved was a positive motivator for opioid reduction prior to surgery.