Primary Arthroplasty Benchmarks of Duration and Magnitude of Opioid Consumption After Total Hip and Knee Arthroplasty: A Database Analysis of 69,368 Patients David J. Cook, BEng a, * , Samuel W. Kaskovich, BSA a , Sean C. Pirkle, BA a , Megan A. Conti Mica, MD b , Lewis L. Shi, MD b , Michael J. Lee, MD b a Pritzker School of Medicine, University of Chicago, Chicago, IL b Department of Orthopedic Surgery and Rehabilitative Medicine, University of Chicago Medicine, Chicago, IL article info Article history: Received 24 October 2018 Received in revised form 9 December 2018 Accepted 16 December 2018 Available online 24 December 2018 Keywords: opioid narcotic prescription total knee arthroplasty total hip arthroplasty orthopedics abstract Background: Opioid prescribing after orthopedic surgeries varies widely, and there is little consensus establishing proper standards of care. This retrospective cohort study examines opioid prescribing trends following total hip (THA) and knee (TKA) arthroplasty and evaluates preoperative opioid use as a pre- dictor of duration and magnitude of postoperative opioid use. Methods: Patients who underwent THA or TKA in a nationwide insurance database were stratified by preoperative opioid use. Naive, sporadic, and chronic users were defined as 0, 1, or 2þ prescriptions filled 6 months before surgery. Patients were excluded for readmission or subsequent surgery. Duration of opioid use was defined as time between the procedure and the last opioid prescription record, and magnitude of opioid use was defined as quantity of pills filled by 30 days postop. Results: Naive patients were less likely than chronic users to fill any opioid prescription after surgery (THA: 61.5% naive vs 90.4% chronic, TKA: 72.0% naive vs 95.9% chronic), and they obtained fewer pills (THA: 73 pills naive vs 126 pills chronic, TKA: 86 pills naive vs 126 pills chronic, 5-mg oxycodone equivalent). Between 10% (THA) and 13% (TKA) of naive and between 47% (THA) and 62% (TKA) of chronic users continued opioid use at 1 year postop. Conclusion: Chronic users obtain more opioids postoperatively and continue filling prescriptions for longer than naive patients. This work benchmarks norms regarding opioid use and furthermore these data highlight the powerful effect of opioid exposure during surgery as 10%-13% of naive patients continued opioids at 1 year postop. © 2018 Elsevier Inc. All rights reserved. The United States is suffering from a profound opioid crisis, with the Centers for Disease Control and Prevention reporting that the number of deaths involving opioids was 5 times higher in 2016 than in 1999 [1]. On average, 115 Americans die every day from an opioid overdose, and an estimated 40% of these deaths involve a pre- scription opioid [2]. When used correctly, prescription opioids can serve as a potent and effective pain control method. However, long- term users of these highly addictive medications are at risk for development of opioid use disorders. Often discussed in this nationwide public health emergency is the role that physicians play in prescribing opioid medication, as research shows that 75%-80% of heroin users state they first misused prescription opioids [3,4]. It is estimated that between 8% and 12% of patients who are pre- scribed opioids for chronic pain eventually develop an opioid use disorder [3e5]. Although the causes of the current opioid crisis are diverse and multivalent, the medical community has acknowl- edged its position within the issue and is grappling with how it can best play a positive role going forward [6e8]. Orthopedic surgery is the third highest opioid-consuming spe- cialty, as we treat both chronic, osteoarthritic pain, as well as acute pain events such as fractures and dislocations [8]. Previous studies have shown that orthopedic surgeons tend to overprescribe opioids after surgery, and that many patients do not consume all of their prescribed pills [9e15]. Additionally, the amount of opioids One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to https://doi.org/10.1016/j.arth.2018.12.023. * Reprint requests: David J. Cook, Pritzker School of Medicine, University of Chicago, 924 East 57th Street, Suite 104, Chicago, IL 60637. Contents lists available at ScienceDirect The Journal of Arthroplasty journal homepage: www.arthroplastyjournal.org https://doi.org/10.1016/j.arth.2018.12.023 0883-5403/© 2018 Elsevier Inc. All rights reserved. The Journal of Arthroplasty 34 (2019) 638e644