Study links outpatient knee surgery to 'extremely high' opioid numbers, dangerous dosages

The average opioid prescription strength for U.S. knee surgery patients was at a dangerously high level from 2015-19, according to researchers from Philadelphia-based Penn Medicine.

Researchers examined insurance claims representing nearly 100,000 patients who underwent arthroscopic knee surgery and had not used any opioid prescriptions in the six months leading up to the procedure. Nationwide, more than 70 percent of patients who hadn't already been taking opioids received a prescription for them.

Six findings from the study, which was published in BMJ Open:

1. The average number of pills prescribed for outpatient knee surgery was "extremely high," said M. Kit Delgado, MD, the study's senior author and an assistant professor of emergency medicine and epidemiology at the University of Pennsylvania's Perelman School of Medicine in Philadelphia.

2. The average prescription equated to about 50 milligrams of morphine per day, a level the CDC has identified as the threshold for increased risk of an opioid overdose death. About 36 percent of patients studied were given a dosage at least this high.

3. The number of tablets in each single prescription ranged from 24 in Vermont to 45 in Oklahoma. While state-level policies may influence variation among patients with a history of opioid use, researchers concluded "practice and organizational styles" may have been more important contributors for patients included in their study.

4. Nationally, 72 percent of patients filled an opioid prescription within three days of their procedure. The fill rate was comparable between noninvasive and invasive procedures.

5. Opioid prescription rates varied widely from state to state, even after researchers adjusted for procedure and patient characteristics.

6. Dr. Delgado, who is involved in a separate study regarding how many opioid tablets patients actually take after knee surgery, said, "The data we've collected show that there's ample opportunity to reduce excessive prescribing for this common outpatient procedure."

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