Hospital-Wide Adherence to Postsurgical Opioid Prescribing Guidelines: A Retrospective Cohort Study.

INTRODUCTION: Lowering opioid prescription doses and quantity decreases the risk of chronic opioid usage. A tool was inserted into the brief operative note for the surgeon to assess the severity of pain associated with the procedure. We studied surgeon adherence to current opioid-prescribing recommendations. METHODS: Retrospective cohort study with 5486 patients were included in the study population. Each patient's prescription was scored yes or no for adherence on total morphine milligram equivalents (MMEs) and days prescribed with the selection in the brief operative note. The entire study population was tested for an increase from the null-hypothesis "benchmark" value of 75% using a one-sided exact binomial test of a single proportion with P < 0.05. This procedure was repeated for subgroups, with P < 0.01. RESULTS: Adherence to guidelines was higher than the 75% benchmark for "total MMEs prescribed" (79.5%; P < 0.001), but lower for "number of days prescribed" (63.5%; P > 0.999). Surgeries with severe predicted pain showed the highest adherence toward total MMEs prescribed at 87.1%, followed by moderate (80.5%) and mild (74.5%). Severe cases also showed the highest adherence in number of days prescribed (92.4%). Adherence to total MMEs prescribed was highest among attending physicians (88.1%) and lowest among residents/fellows (76.6%). CONCLUSIONS: Adherence to current guidelines was 79.5% for MMEs prescribed but only 63.5% for days prescribed. Compliance with guidelines was better for severe procedures than mild or moderate. Differences were seen across surgical departments. While an improvement from previous reports, further improvement is needed to reduce the number of days of opioids prescribed and increase compliance with recommended guidelines.

The Use of Intraoperative Digital Radiography Alignment Software to Assess Implant Placement in Total Hip Arthroplasty.

PURPOSE OF REVIEW: Total hip arthroplasty (THA) is a highly successful surgery with growing rates of utilization in the USA, but surgical outliers leading to postoperative complications remain a concern. There is need for a standard system of accurate, predictable intraoperative evaluation to decrease component positioning outliers. Many current intraoperative imaging systems have shown promise, but there are drawbacks that have led to slow adoption. Digital radiography, in conjunction with Radlink™ technology, is a potential solution to this problem. This review summarizes the clinical application and scientific literature regarding the use of Radlink™ in THA. RECENT FINDINGS: Traditional surgeon-directed component placement can result in surgical outliers. This is especially true not only among low-volume arthroplasty surgeons, but can also occur with experienced, high-volume surgeons. Digital radiography allows for more precise and accurate placement of the acetabular cup in a targeted range in an effort to improve THA outcomes. Intraoperative images are obtained quickly, and they are accurate when compared to postoperative images. Additionally, the use of Radlink™ results in a significant decrease in leg length and femoral offset outliers. The adoption of Radlink™ technology in THA can significantly decrease surgical outliers, especially errors in acetabular cup placement, leg length, and femoral offset. Digital radiography avoids many of the previous aversions to intraoperative imaging as it produces a fast, reliable image with little radiation exposure and minimal interruption to workflow. There is the potential for Radlink™ use to provide superior patient outcomes, as a decrease in surgical outliers can minimize implant malpositioning with resultant need for revision THAs. Radlink™ may also provide benefit in analyzing other parameters, such as component sizing.