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  1. Safe Use Initiative

Optimizing the Use of Opioids Following Surgery

Performer: Kaiser Foundation Research Institute and Kaiser Permanente Northwest Center for Health Research

Principal Investigator: David H. Smith, PhD, RPh

Project Duration: 9/21/14 - 3/31/17

Regulatory Science Challenge

Patients often receive opioid or other analgesic medication for acute pain management after surgery. Some patients are at risk of entering a cycle of opioid use that becomes difficult to manage. As opioid exposure is continued, patients may develop tolerance and dependence. For some, post-operative opioid exposure will eventually lead to addiction. Despite the common post-surgical use of opioids, patients and their health care practitioners often do not have an optimal plan for managing opioid exposure.

Project Description

Project investigators used data from the Kaiser Permanente Northwest health system to refine an existing prediction tool to identify patients at high risk for long-term opioid use following orthopedic surgery. Patients at the highest risk were then selected for a prospective, randomized, educational project to inform patients undergoing total hip and total knee replacement surgery about opioid analgesia.

The educational intervention consisted of mailed handouts (before and after surgery) that were aimed at increasing patient knowledge of opioid benefits and downsides, followed by a pharmacist outreach call if opioid use continued more than four weeks after surgery. A subset of patients was pilot tested to identify potential concerns and fine-tune educational efforts before full-scale implementation. The educational intervention was then evaluated for effectiveness in reducing opioid use; the control group received usual care but no additional education.

Project Goals

  • Refine an existing prediction tool to identify patients at high risk for long-term opioid use following orthopedic surgery.
  • Develop an educational intervention, tailored to orthopedic surgery patients, that can be implemented before and after surgery.
  • Decrease the amount and duration of opioid use in patients undergoing hip and knee replacement surgery.

Project Results

The final report from the researchers to the FDA included the following results:

  •  A total of 561 patients were randomized. The mean age was 66 years; 60% were female.
  • Overall, there was not a meaningful reduction in opioid use between the intervention and control groups.
  • However, for patients undergoing hip replacement, the intervention group used significantly less opioids than the control group (geometric mean ratio 0.52 (95% CI 0.33, 0.82)).  

Publications

Smith DH, Kuntz JL, DeBar LL, Mesa J, Yang X, Schneider J, Petrik A, Reese K, Thorsness LA, Boardman D, Johnson ES. A randomized, pragmatic, pharmacist-led intervention reduced opioids following orthopedic surgery. Am J Manag Care. 2018 Nov;24(11):515-521. PMID: 30452208.
 

 
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