A Comparison of Postoperative Pain and Narcotic Prescriptions in Patients Undergoing Total Hip Arthroplasty Electively or for Femoral Neck Fracture

摘要

The opioid epidemic has forced orthopaedic surgeons to reevaluate prescribing patterns and led hospitals to develop postoperative opioid-sparing protocols for patients undergoing total hip arthroplasty (THA). The purpose of this study was to investigate patient-reported pain and narcotic requirements in patients undergoing THA for fracture (F-THA) or nonfracture diagnoses (THA-E). A retrospective analysis was performed on patients who underwent primary THA at a single academic institution between January 2013 and December 2020. Patients with postoperative opioid prescription and Visual Analog Scale (VAS) pain score data were included. Patients who underwent primary THA with a diagnosis of femoral neck fracture (THA-F) were matched 1:1 with patients without primary fracture diagnoses (THA-E) using nearest-neighbor propensity-score matching. Operative time, length of stay (LOS), discharge disposition, 90-day readmission rates, 90-day opioid prescription amounts (quantified by morphine milligram equivalents MME), and daily postoperative VAS pain scores (averaged over 24-hour periods) were compared. A total of 8,714 patients met inclusion criteria (THA-E: 8,362; THA-F: 352). The THA-F group was older and had a higher proportion of females and a lower mean body mass index than the THA-E group. There were 331 THA-F patients successfully matched to 331 THA-E patients. Operative time (113.6?±?41.3 vs. 914.9?±?32.6?minutes, p?