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Tapered Dose Postoperative Opioid Prescriptions Following Inpatient Total Hip and Knee Arthroplasty: Quality Improvement Study and Retrospective Review. J Arthroplasty 2023 Feb;38(2):239-244



Pubmed ID




Scopus ID

2-s2.0-85138793621 (requires institutional sign-in at Scopus site)   1 Citation


BACKGROUND: Overprescription of pain medications directly fuels the opioid epidemic. Veterans are profoundly impacted. Tapered dose protocols may reduce excessive prescribing.

METHODS: A retrospective study of adult veterans who presented to our institution for primary total knee arthroplasty or total hip arthroplasty (THA) was performed. Postdischarge opioid use was reviewed before and after an opioid taper prescription protocol. The preprotocol and postprotocol groups had 299 and 89 veterans, respectively. Total Morphine Milligram Equivalent (MME) prescribed postdischarge, number of tablets prescribed, number of refills issued, 30-day emergency department visits, and 30-day readmissions were compared. Opioid naïve and chronic opioid users were both included.

RESULTS: Preprotocol and postprotocol implementation group, in combination with surgery type (total knee arthroplasty versus THA) and opioid naïve status, predicted MME. On average, the postprotocol group received 224 MME less, THA patients received 177 MME less, and nonopioid naïve patients received 152 MME more.

CONCLUSION: The opioid taper protocol led to less opioid administration after discharge. Taper protocols should be considered for postoperative pain management.

LEVEL OF EVIDENCE: III, retrospective comparison study.

Author List

Kukushliev VV, Sherman KA, Kurylo CM, Ortmann SD, Scheidt RA, Scheidt KB


Karl B. Scheidt MD Associate Professor in the Orthopaedic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Analgesics, Opioid
Arthroplasty, Replacement, Knee
Pain, Postoperative
Patient Discharge
Practice Patterns, Physicians'
Quality Improvement
Retrospective Studies