Comparing Surgeon Perceptions of Pre- and Postoperative Opioid Use with Actual Opioid Use in Patients Undergoing Primary Total Knee Arthroplasty

Introduction: Surgeons' expectations regarding the duration of their patients' opioid use may not match reality, hindering coordinated opioid stewardship with nonsurgeon prescribers of opioid analgesics. We compared surgeons' perceptions of pre- and postoperative opioid use in patients undergoing primary total knee arthroplasty (TKA) at Stanford with opioid prescription data extracted from California's prescription drug monitoring database (CURES). Methods: This study was institutional review board exempted. California's Department of Justice approved use of CURES data. We identified 189 adult patients who underwent primary TKA at Stanford over an eight-month period, excluding patients on opioid maintenance therapy. We extracted demographic data from electronic health records and opioid prescription data from CURES. Orthopedic surgery residents, fellows, and attendings at Stanford received a survey that asked them to estimate the percentage of patients using opioids in the month before TKA and one to three months postoperatively. Results: Fourteen point eight percent of patients filled at least one opioid prescription within the month before surgery. Almost all (93.1%) filled an opioid prescription within two weeks after surgery, consistent with our surgeons' prescribing patterns. However, 33.9% of patients filled at least one opioid prescription one to three months after surgery. Survey results have not been fully collected at the time of writing this abstract but will be presented at the meeting. Discussion: Expected benefits of this study include 1) identifying any mismatch between surgeon perceptions vs reality regarding patients' opioid use associated with TKA and 2) informing the design of future projects aimed at reducing prescription opioid use after surgeries.