Optimizing Postoperative Opioid Prescribing in Veterans Undergoing Total Hip or Knee Arthroplasties

Opioid prescribing following orthopedic surgeries, such as total hip arthroplasties (THA) and total knee arthroplasties (TKA), is a critical focus area given the risks of dependence, adverse effects, and overprescribing. This single-center, retrospective quality improvement study evaluated postoperative opioid prescribing patterns among 142 opioid-naïve Veterans discharged from the Kansas City Veterans Affairs Medical Center (KCVAMC) following THA or TKA between September 2023 and September 2024. Patients who underwent TKA received higher inpatient and discharge morphine equivalent daily doses (MEDD) than THA patients, despite similar pain scores. Notably, 11% of patients were discharged with opioids despite no inpatient opioid use in the 24-h period immediately preceding discharge. The findings from this study reveal inconsistent prescribing and documentation practices, highlighting opportunities to improve care. Recommendations include implementing a standardized multimodal analgesia discharge order set with guideline-concordant opioid quantities, encouragement of non-opioid analgesic use, and inclusion of a naloxone prescription.