• Trevor R Grace, Kevin J Choo, Joseph T Patterson, Krishn Khanna, Brian T Feeley, and Alan L Zhang.
• From the Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA.
• J Am Acad Orthop Surg. 2020 Apr 1; 28 (7): 279-286.

IntroductionTailoring opioid prescriptions to inpatient use after orthopaedic procedures may effectively control pain while limiting overprescription but may not be common in the current orthopaedic practice.MethodsA retrospective review identified opioid-naïve patients admitted after any orthopaedic procedure. Daily and total prescription quantities as well as patient-specific factors were collected. The total opioids used the day before discharge was compared with the total opioids prescribed for the day after discharge. Refill rates were then compared between patients whose daily discharge prescription regimen far exceeded or approximated their predischarge opioid consumption.ResultsSix hundred thirteen patients were included (ages 18 to 95 years). The total opioids prescribed for the 24 hours after discharge significantly exceeded the opioids consumed the 24 hours before discharge for each orthopaedic subspecialty. The excessive-prescription group (409 patients) received greater daily opioid (120 oral morphine equivalents [OMEs] versus 60 OMEs; P < 0.01) and total opioid (750 OMEs versus 512.5 OMEs; P < 0.01) at discharge but was more likely to refill their opioid prescription within 30 days of discharge (27.6% versus 20.1%; P = 0.043).DiscussionOpioid regimens prescribed after an orthopaedic surgery frequently exceed inpatient opioid use. Opioid regimens that approximate inpatient use may help curb overprescription and are not associated with higher refill rates compared with more excessive prescriptions.Level Of EvidenceLevel III, Retrospective Cohort Study.

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