Opioid Consumption After Hospital Discharge in Orthopedic Surgery

After being discharged from the hospital, opioids are major source of pain relief for
patients. Previous studies show that 71% of patients prescribed opioid medications after
thoracic surgery admitted to taking half or less of their prescribed opioid medications. The
analysis showed a correlation between the amount of opioids consumed during the patient
hospitalization and after discharge. Goesling et al. surveyed patients with or without
previous history of opioid use who underwent total knee arthroplasty (TKA) or total hip
arthroplasty (THA). Both groups were followed for 6 months to document the "natural history"
of opioid use postoperatively and post discharge. For patients with preoperative opioid use
undergoing TKA, 88.5% were shown to be using opioids after 1 month, 48.2% after 3 months and
53.5% after 6 months. For patients considered opioid naïve undergoing TKA, 66.5% were shown
to be using opioids after 1 month, 16.6% after 3 months and 8.2% after 6 months. For patients
with preoperative opioid use undergoing THA, 63.9% were shown to be using opioids after 1
month, 37.8% after 3 months and 34.7% after 6 months. For patients considered opioid naïve
undergoing THA, 22.5% were shown to be using opioids after 1 month, 4.4% after 3 months and
4.3% after 6 months.

This study is observational and involves consenting adult patients undergoing major
orthopedic surgery to pre-operative assessments including the Self Administered Gerocognitive
Exam (SAGE) questionnaire, a cognitive test to identify mild-moderate cognitive impairment,
and collection of demographic data and medical history. Phone call follow-ups include
assessments of post-discharge pain and opioid consumption, and completing verbally an adapted
Activities of Daily Living questionnaire. No additional risks have been identified by
participating in this study. Participants may not directly benefit from participating in this
trial, but the data collected could provide valuable insight into the discrepancy between
required opioid pain medications and opioid pain medication prescription for adequate pain
management. This insight could then be applied to reevaluate post-discharge pain management
procedures and standards of care, therefore curbing opioid use and abuse trends.

Inclusion Criteria:

- Male or female, 18 years of age and older, undergoing orthopedic procedures (hip or
knee arthroplasty)

- Capable and willing to consent

- Participants literate in English language

Exclusion Criteria:

- History of drug and /or alcohol abuse/ dependency

- Ketamine use during hospitalization

- Illiteracy

- Presence of a clinically diagnosed major psychiatric condition such as bipolar
disorder, uncontrolled major depression, schizophrenia

- Any condition that the principle investigator may disqualify the patient